- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $363.66 / $1,543.03 / $6,537.60
| Facility | | $363.66 | $1,543.03 | $6,537.60 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $230.18 / $278.33 / $471.77
| Professional | | $230.18 | $278.33 | $471.77 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $216.72 / $299.95 / $503.41
| Professional | | $216.72 | $299.95 | $503.41 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $312.45 / $429.82 / $535.29
| Professional | | $312.45 | $429.82 | $535.29 |
- 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
- $197.89 / $347.46 / $578.05
| Professional | | $197.89 | $347.46 | $578.05 |