- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $170.82 / $1,271.33 / $6,325.92
| Facility | | $170.82 | $1,271.33 | $6,325.92 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $66.40 / $311.20 / $494.75
| Professional | | $66.40 | $311.20 | $494.75 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $90.39 / $145.94 / $741.02
| Professional | | $90.39 | $145.94 | $741.02 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,190.29 / $2,380.02 / $3,423.36
| Facility | | $1,190.29 | $2,380.02 | $3,423.36 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $475.29 / $682.79 / $1,352.81
| Professional | | $475.29 | $682.79 | $1,352.81 |