- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,630.27 / $4,786.30 / $10,232.93
| Facility | | $2,630.27 | $4,786.30 | $10,232.93 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $173.78 / $245.47 / $588.84
| Facility | | $173.78 | $245.47 | $588.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $138.04 / $173.78 / $281.84
| Professional | | $138.04 | $173.78 | $281.84 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $575.44 / $2,041.74 / $6,456.54
| Facility | | $575.44 | $2,041.74 | $6,456.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $43.65 / $60.26 / $107.15
| Professional | | $43.65 | $60.26 | $107.15 |