- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $372.12 / $891.56 / $3,706.14
| Facility | | $372.12 | $891.56 | $3,706.14 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $58.65 / $148.16 / $575.47
| Professional | | $58.65 | $148.16 | $575.47 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $89.93 / $305.45 / $538.86
| Professional | | $89.93 | $305.45 | $538.86 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $119.59 / $310.56 / $987.38
| Professional | | $119.59 | $310.56 | $987.38 |
- 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
- $471.54 / $684.42 / $929.43
| Professional | | $471.54 | $684.42 | $929.43 |