- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $85.11 / $794.33 / $2,041.74
| Facility | | $85.11 | $794.33 | $2,041.74 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $57.54 / $128.82 / $190.55
| Professional | | $57.54 | $128.82 | $190.55 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $162.18 / $162.18 / $213.80
| Professional | | $162.18 | $162.18 | $213.80 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $70.79 / $123.03 / $302.00
| Professional | | $70.79 | $123.03 | $302.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $128.82 / $331.13 / $851.14
| Facility | | $128.82 | $331.13 | $851.14 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $63.10 / $138.04 / $309.03
| Professional | | $63.10 | $138.04 | $309.03 |