- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $61.81 / $2,922.00 / $5,743.00
| Facility | | $61.81 | $2,922.00 | $5,743.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $130.46 / $210.95 / $288.29
| Professional | | $130.46 | $210.95 | $288.29 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $168.11 / $199.95 / $297.42
| Professional | | $168.11 | $199.95 | $297.42 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $117.15 / $135.98 / $177.92
| Professional | | $117.15 | $135.98 | $177.92 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $177.98 / $248.74 / $292.39
| Professional | | $177.98 | $248.74 | $292.39 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,078.00 / $1,556.00 / $4,495.00
| Facility | | $1,078.00 | $1,556.00 | $4,495.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $132.99 / $178.36 / $299.01
| Professional | | $132.99 | $178.36 | $299.01 |