- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $220.94 / $2,667.66 / $19,557.12
| Facility | | $220.94 | $2,667.66 | $19,557.12 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $183.08 / $241.52 / $349.98
| Professional | | $183.08 | $241.52 | $349.98 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $371.50 / $435.94 / $512.87
| Professional | | $371.50 | $435.94 | $512.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $239.55 / $414.32 / $668.79
| Professional | | $239.55 | $414.32 | $668.79 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $188.82 / $375.60 / $1,632.40
| Facility | | $188.82 | $375.60 | $1,632.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $239.58 / $410.83 / $572.54
| Professional | | $239.58 | $410.83 | $572.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $262.55 / $437.58 / $572.54
| Professional | | $262.55 | $437.58 | $572.54 |