- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $660.42 / $727.42 / $3,955.04
| Facility | | $660.42 | $727.42 | $3,955.04 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $32.34 / $50.74 / $70.66
| Professional | | $32.34 | $50.74 | $70.66 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $35.86 / $54.72 / $91.14
| Professional | | $35.86 | $54.72 | $91.14 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $50.01 / $74.23 / $98.03
| Professional | | $50.01 | $74.23 | $98.03 |
- 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
- $36.17 / $71.08 / $108.73
| Professional | | $36.17 | $71.08 | $108.73 |