- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $40.74 / $1,122.02 / $3,981.07
| Facility | | $40.74 | $1,122.02 | $3,981.07 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $28.84 / $660.69 / $891.25
| Professional | | $28.84 | $660.69 | $891.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $30.20 / $602.56 / $1,230.27
| Professional | | $30.20 | $602.56 | $1,230.27 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $758.58 / $758.58 / $758.58
| Professional | | $758.58 | $758.58 | $758.58 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,148.15 / $1,479.11 / $1,949.84
| Professional | | $1,148.15 | $1,479.11 | $1,949.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $23.99 / $537.03 / $1,288.25
| Professional | | $23.99 | $537.03 | $1,288.25 |