- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $33.11 / $2,137.96 / $3,388.44
| Facility | | $33.11 | $2,137.96 | $3,388.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $30.20 / $50.12 / $891.25
| Professional | | $30.20 | $50.12 | $891.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $234.42 / $380.19 / $537.03
| Professional | | $234.42 | $380.19 | $537.03 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $371.54 / $371.54 / $371.54
| Facility | | $371.54 | $371.54 | $371.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $109.65 / $398.11 / $676.08
| Professional | | $109.65 | $398.11 | $676.08 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $52.48 / $70.79 / $109.65
| Professional | | $52.48 | $70.79 | $109.65 |