- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $85.18 / $1,985.86 / $3,496.92
| Facility | | $85.18 | $1,985.86 | $3,496.92 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $81.18 / $220.05 / $342.68
| Professional | | $81.18 | $220.05 | $342.68 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $100.07 / $190.10 / $381.05
| Professional | | $100.07 | $190.10 | $381.05 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,144.44 / $1,344.38 / $1,909.64
| Facility | | $1,144.44 | $1,344.38 | $1,909.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $140.07 / $141.82 / $147.78
| Professional | | $140.07 | $141.82 | $147.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $217.40 / $306.83 / $587.79
| Professional | | $217.40 | $306.83 | $587.79 |