- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $52.72 / $581.63 / $3,020.02
| Facility | | $52.72 | $581.63 | $3,020.02 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $43.42 / $52.16 / $53.03
| Professional | | $43.42 | $52.16 | $53.03 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $44.42 / $66.77 / $86.91
| Professional | | $44.42 | $66.77 | $86.91 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $393.03 / $574.49 / $1,713.78
| Facility | | $393.03 | $574.49 | $1,713.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $58.04 / $71.69 / $167.95
| Professional | | $58.04 | $71.69 | $167.95 |