- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $517.82 / $660.42 / $1,543.03
| Facility | | $517.82 | $660.42 | $1,543.03 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $37.21 / $53.55 / $77.92
| Professional | | $37.21 | $53.55 | $77.92 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $39.13 / $59.02 / $106.00
| Professional | | $39.13 | $59.02 | $106.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $54.75 / $80.64 / $107.93
| Professional | | $54.75 | $80.64 | $107.93 |
- 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
- $48.26 / $77.61 / $126.51
| Professional | | $48.26 | $77.61 | $126.51 |