- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $320.32 / $338.10 / $3,955.04
| Facility | | $320.32 | $338.10 | $3,955.04 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $78.02 / $114.10 / $174.61
| Professional | | $78.02 | $114.10 | $174.61 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $80.84 / $106.22 / $220.84
| Professional | | $80.84 | $106.22 | $220.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $104.98 / $162.08 / $219.93
| Professional | | $104.98 | $162.08 | $219.93 |
- 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
- $93.73 / $144.15 / $222.96
| Professional | | $93.73 | $144.15 | $222.96 |