- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $426.58 / $794.33 / $3,715.35
| Facility | | $426.58 | $794.33 | $3,715.35 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $66.07 / $125.89 / $281.84
| Professional | | $66.07 | $125.89 | $281.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $61.66 / $112.20 / $173.78
| Professional | | $61.66 | $112.20 | $173.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $83.18 / $158.49 / $302.00
| Professional | | $83.18 | $158.49 | $302.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $416.87 / $1,412.54 / $6,456.54
| Facility | | $416.87 | $1,412.54 | $6,456.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $83.18 / $123.03 / $218.78
| Professional | | $83.18 | $123.03 | $218.78 |