- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,513.56 / $1,548.82 / $3,981.07
| Facility | | $1,513.56 | $1,548.82 | $3,981.07 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $19.95 / $61.66 / $138.04
| Professional | | $19.95 | $61.66 | $138.04 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $16.98 / $39.81 / $85.11
| Professional | | $16.98 | $39.81 | $85.11 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $23.44 / $53.70 / $154.88
| Professional | | $23.44 | $53.70 | $154.88 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $416.87 / $1,412.54 / $6,456.54
| Facility | | $416.87 | $1,412.54 | $6,456.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $23.44 / $51.29 / $114.82
| Professional | | $23.44 | $51.29 | $114.82 |