- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $74.13 / $1,698.24 / $4,168.69
| Facility | | $74.13 | $1,698.24 | $4,168.69 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $123.03 / $181.97 / $436.52
| Professional | | $123.03 | $181.97 | $436.52 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $114.82 / $151.36 / $234.42
| Professional | | $114.82 | $151.36 | $234.42 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $117.49 / $218.78 / $316.23
| Professional | | $117.49 | $218.78 | $316.23 |
- 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
- $125.89 / $199.53 / $281.84
| Professional | | $125.89 | $199.53 | $281.84 |