- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $393.30 / $669.79 / $7,270.01
| Facility | | $393.30 | $669.79 | $7,270.01 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $109.31 / $130.66 / $156.66
| Professional | | $109.31 | $130.66 | $156.66 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $188.00 / $271.00 / $361.00
| Professional | | $188.00 | $271.00 | $361.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $122.28 / $186.68 / $272.36
| Professional | | $122.28 | $186.68 | $272.36 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $293.00 / $293.00 / $3,239.00
| Facility | | $293.00 | $293.00 | $3,239.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $130.35 / $241.37 / $379.50
| Professional | | $130.35 | $241.37 | $379.50 |