- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $417.26 / $1,521.57 / $3,955.04
| Facility | | $417.26 | $1,521.57 | $3,955.04 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $47.50 / $75.70 / $118.96
| Professional | | $47.50 | $75.70 | $118.96 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $52.21 / $85.19 / $140.24
| Professional | | $52.21 | $85.19 | $140.24 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $75.86 / $108.56 / $164.52
| Professional | | $75.86 | $108.56 | $164.52 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,388.00 / $2,445.00 / $4,602.00
| Facility | | $1,388.00 | $2,445.00 | $4,602.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $68.64 / $119.56 / $184.03
| Professional | | $68.64 | $119.56 | $184.03 |