- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $234.42 / $933.25 / $1,698.24
| Facility | | $234.42 | $933.25 | $1,698.24 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $234.42 / $426.58 / $549.54
| Professional | | $234.42 | $426.58 | $549.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3.24 / $3.24 / $6.17
| Professional | | $3.24 | $3.24 | $6.17 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $117.49 / $741.31 / $1,445.44
| Facility | | $117.49 | $741.31 | $1,445.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $602.56 / $616.60 / $776.25
| Professional | | $602.56 | $616.60 | $776.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $186.21 / $194.98 / $204.17
| Professional | | $186.21 | $194.98 | $204.17 |