- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,096.48 / $1,445.44 / $2,398.83
| Facility | | $1,096.48 | $1,445.44 | $2,398.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $40.74 / $67.61 / $107.15
| Professional | | $40.74 | $67.61 | $107.15 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $562.34 / $676.08 / $912.01
| Facility | | $562.34 | $676.08 | $912.01 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $47.86 / $72.44 / $114.82
| Professional | | $47.86 | $72.44 | $114.82 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $46.77 / $81.28 / $138.04
| Professional | | $46.77 | $81.28 | $138.04 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $239.88 / $512.86 / $1,348.96
| Facility | | $239.88 | $512.86 | $1,348.96 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $39.81 / $64.57 / $104.71
| Professional | | $39.81 | $64.57 | $104.71 |