- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $218.78 / $2,754.23 / $4,073.80
| Facility | | $218.78 | $2,754.23 | $4,073.80 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $123.03 / $208.93 / $407.38
| Professional | | $123.03 | $208.93 | $407.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $245.47 / $275.42 / $323.59
| Professional | | $245.47 | $275.42 | $323.59 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $223.87 / $239.88 / $478.63
| Professional | | $223.87 | $239.88 | $478.63 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $165.96 / $549.54 / $5,888.44
| Facility | | $165.96 | $549.54 | $5,888.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $354.81 / $478.63 / $776.25
| Professional | | $354.81 | $478.63 | $776.25 |