- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $150.66 / $1,284.28 / $7,440.78
| Facility | | $150.66 | $1,284.28 | $7,440.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $39.69 / $58.63 / $151.46
| Professional | | $39.69 | $58.63 | $151.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $55.76 / $110.03 / $204.76
| Professional | | $55.76 | $110.03 | $204.76 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,551.73 / $3,551.73 / $3,551.73
| Facility | | $3,551.73 | $3,551.73 | $3,551.73 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $130.30 / $181.46 / $286.66
| Professional | | $130.30 | $181.46 | $286.66 |