- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $200.34 / $3,706.14 / $3,955.04
| Facility | | $200.34 | $3,706.14 | $3,955.04 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $102.02 / $190.64 / $251.61
| Professional | | $102.02 | $190.64 | $251.61 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $145.84 / $245.45 / $386.39
| Professional | | $145.84 | $245.45 | $386.39 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $160.13 / $232.84 / $390.90
| Professional | | $160.13 | $232.84 | $390.90 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $540.00 / $1,183.00 / $4,915.00
| Facility | | $540.00 | $1,183.00 | $4,915.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $170.30 / $253.95 / $441.95
| Professional | | $170.30 | $253.95 | $441.95 |