- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $616.60 / $2,454.71 / $4,466.84
| Facility | | $616.60 | $2,454.71 | $4,466.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $40.74 / $85.11 / $177.83
| Professional | | $40.74 | $85.11 | $177.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $36.31 / $58.88 / $102.33
| Professional | | $36.31 | $58.88 | $102.33 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $48.98 / $83.18 / $123.03
| Professional | | $48.98 | $83.18 | $123.03 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $436.52 / $1,412.54 / $6,456.54
| Facility | | $436.52 | $1,412.54 | $6,456.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $40.74 / $66.07 / $114.82
| Professional | | $40.74 | $66.07 | $114.82 |