- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $44.67 / $1,288.25 / $1,412.54
| Facility | | $44.67 | $1,288.25 | $1,412.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $32.36 / $47.86 / $1,698.24
| Professional | | $32.36 | $47.86 | $1,698.24 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $407.38 / $741.31 / $1,230.27
| Professional | | $407.38 | $741.31 | $1,230.27 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $758.58 / $1,071.52 / $1,513.56
| Professional | | $758.58 | $1,071.52 | $1,513.56 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,096.48 / $1,096.48 / $1,096.48
| Professional | | $1,096.48 | $1,096.48 | $1,096.48 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $41.69 / $66.07 / $97.72
| Professional | | $41.69 | $66.07 | $97.72 |