- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $133.84 / $343.99 / $6,053.21
| Facility | | $133.84 | $343.99 | $6,053.21 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $131.82 / $284.92 / $323.42
| Professional | | $131.82 | $284.92 | $323.42 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $132.57 / $243.23 / $467.34
| Professional | | $132.57 | $243.23 | $467.34 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,113.20 / $5,985.82 / $24,514.46
| Facility | | $5,113.20 | $5,985.82 | $24,514.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $291.79 / $400.87 / $664.37
| Professional | | $291.79 | $400.87 | $664.37 |