- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,445.44 / $5,248.07 / $10,232.93
| Facility | | $1,445.44 | $5,248.07 | $10,232.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $52.48 / $112.20 / $275.42
| Professional | | $52.48 | $112.20 | $275.42 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $66.07 / $128.82 / $331.13
| Professional | | $66.07 | $128.82 | $331.13 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $102.33 / $154.88 / $213.80
| Professional | | $102.33 | $154.88 | $213.80 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $45.71 / $117.49 / $363.08
| Professional | | $45.71 | $117.49 | $363.08 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,412.54 / $2,884.03 / $7,762.47
| Facility | | $1,412.54 | $2,884.03 | $7,762.47 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $47.86 / $104.71 / $229.09
| Professional | | $47.86 | $104.71 | $229.09 |