- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $142.46 / $405.24 / $7,656.38
| Facility | | $142.46 | $405.24 | $7,656.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $140.12 / $355.11 / $438.36
| Professional | | $140.12 | $355.11 | $438.36 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $140.43 / $259.04 / $701.88
| Professional | | $140.43 | $259.04 | $701.88 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,394.20 / $5,113.20 / $10,192.45
| Facility | | $4,394.20 | $5,113.20 | $10,192.45 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $377.10 / $868.29 / $871.34
| Professional | | $377.10 | $868.29 | $871.34 |