- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $30.20 / $436.52 / $2,818.38
| Facility | | $30.20 | $436.52 | $2,818.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $30.20 / $45.71 / $1,096.48
| Professional | | $30.20 | $45.71 | $1,096.48 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $436.52 / $676.08 / $1,258.93
| Professional | | $436.52 | $676.08 | $1,258.93 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $50.12 / $2,570.40 / $5,623.41
| Facility | | $50.12 | $2,570.40 | $5,623.41 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $154.88 / $489.78 / $794.33
| Professional | | $154.88 | $489.78 | $794.33 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $42.66 / $58.88 / $79.43
| Professional | | $42.66 | $58.88 | $79.43 |