- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $483.36 / $739.13 / $3,955.04
| Facility | | $483.36 | $739.13 | $3,955.04 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $135.00 / $183.17 / $255.46
| Professional | | $135.00 | $183.17 | $255.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $134.94 / $232.43 / $376.38
| Professional | | $134.94 | $232.43 | $376.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $181.37 / $312.77 / $517.72
| Professional | | $181.37 | $312.77 | $517.72 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $540.00 / $1,401.00 / $4,915.00
| Facility | | $540.00 | $1,401.00 | $4,915.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $176.83 / $284.88 / $556.20
| Professional | | $176.83 | $284.88 | $556.20 |