- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $478.63 / $1,548.82 / $4,570.88
| Facility | | $478.63 | $1,548.82 | $4,570.88 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $30.20 / $75.86 / $223.87
| Professional | | $30.20 | $75.86 | $223.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $22.91 / $41.69 / $67.61
| Professional | | $22.91 | $41.69 | $67.61 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $31.62 / $61.66 / $114.82
| Professional | | $31.62 | $61.66 | $114.82 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $416.87 / $1,412.54 / $6,456.54
| Facility | | $416.87 | $1,412.54 | $6,456.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $28.18 / $48.98 / $102.33
| Professional | | $28.18 | $48.98 | $102.33 |