- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $0.83 / $1,513.56 / $3,981.07
| Facility | | $0.83 | $1,513.56 | $3,981.07 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $93.33 / $208.93 / $407.38
| Professional | | $93.33 | $208.93 | $407.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $69.18 / $123.03 / $199.53
| Professional | | $69.18 | $123.03 | $199.53 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $87.10 / $158.49 / $281.84
| Professional | | $87.10 | $158.49 | $281.84 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,380.38 / $2,454.71 / $6,025.60
| Facility | | $1,380.38 | $2,454.71 | $6,025.60 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $74.13 / $141.25 / $257.04
| Professional | | $74.13 | $141.25 | $257.04 |