- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $236.45 / $707.44 / $9,885.54
| Facility | | $236.45 | $707.44 | $9,885.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $194.03 / $228.59 / $286.60
| Professional | | $194.03 | $228.59 | $286.60 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $205.35 / $301.39 / $406.03
| Professional | | $205.35 | $301.39 | $406.03 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,316.59 / $3,316.59 / $3,316.59
| Facility | | $3,316.59 | $3,316.59 | $3,316.59 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $236.66 / $284.69 / $639.86
| Professional | | $236.66 | $284.69 | $639.86 |