- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $442.63 / $1,137.58 / $18,451.18
| Facility | | $442.63 | $1,137.58 | $18,451.18 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $387.97 / $430.10 / $442.64
| Professional | | $387.97 | $430.10 | $442.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $412.66 / $546.51 / $790.36
| Professional | | $412.66 | $546.51 | $790.36 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,443.55 / $5,130.85 / $12,676.96
| Facility | | $1,443.55 | $5,130.85 | $12,676.96 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $428.70 / $554.79 / $1,006.55
| Professional | | $428.70 | $554.79 | $1,006.55 |