- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $138.04 / $891.25 / $8,511.38
| Facility | | $138.04 | $891.25 | $8,511.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $147.91 / $354.81 / $851.14
| Professional | | $147.91 | $354.81 | $851.14 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $181.97 / $269.15 / $501.19
| Professional | | $181.97 | $269.15 | $501.19 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,165.95 / $7,413.10 / $15,135.61
| Facility | | $6,165.95 | $7,413.10 | $15,135.61 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,000.00 / $1,000.00 / $1,000.00
| Facility | | $1,000.00 | $1,000.00 | $1,000.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $169.82 / $245.47 / $457.09
| Professional | | $169.82 | $245.47 | $457.09 |