- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $377.31 / $710.37 / $3,955.04
| Facility | | $377.31 | $710.37 | $3,955.04 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $62.23 / $106.82 / $583.29
| Professional | | $62.23 | $106.82 | $583.29 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $95.11 / $311.35 / $548.50
| Professional | | $95.11 | $311.35 | $548.50 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $126.46 / $314.54 / $1,014.77
| Professional | | $126.46 | $314.54 | $1,014.77 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $540.00 / $1,183.00 / $4,915.00
| Facility | | $540.00 | $1,183.00 | $4,915.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $484.28 / $703.41 / $942.85
| Professional | | $484.28 | $703.41 | $942.85 |