- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $89.13 / $2,570.40 / $6,760.83
| Facility | | $89.13 | $2,570.40 | $6,760.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $57.54 / $107.15 / $251.19
| Professional | | $57.54 | $107.15 | $251.19 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $112.20 / $691.83 / $1,778.28
| Facility | | $112.20 | $691.83 | $1,778.28 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $128.82 / $154.88 / $234.42
| Professional | | $128.82 | $154.88 | $234.42 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $831.76 / $1,380.38 / $2,344.23
| Facility | | $831.76 | $1,380.38 | $2,344.23 |