- 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
- $131.83 / $181.97 / $436.52
| Facility | | $131.83 | $181.97 | $436.52 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $102.33 / $131.83 / $213.80
| Professional | | $102.33 | $131.83 | $213.80 |
- 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
- $19.95 / $30.90 / $63.10
| Professional | | $19.95 | $30.90 | $63.10 |