- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $614.45 / $1,869.65 / $3,706.14
| Facility | | $614.45 | $1,869.65 | $3,706.14 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $64.66 / $161.36 / $499.65
| Professional | | $64.66 | $161.36 | $499.65 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $97.91 / $297.77 / $514.65
| Professional | | $97.91 | $297.77 | $514.65 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $98.76 / $246.78 / $941.84
| Professional | | $98.76 | $246.78 | $941.84 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,069.00 / $1,788.00 / $4,602.00
| Facility | | $1,069.00 | $1,788.00 | $4,602.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $448.81 / $652.85 / $899.31
| Professional | | $448.81 | $652.85 | $899.31 |