- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $157.54 / $1,325.06 / $4,250.54
| Facility | | $157.54 | $1,325.06 | $4,250.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $128.53 / $157.54 / $340.74
| Professional | | $128.53 | $157.54 | $340.74 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $153.62 / $177.54 / $1,410.00
| Professional | | $153.62 | $177.54 | $1,410.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $137.75 / $198.28 / $334.85
| Professional | | $137.75 | $198.28 | $334.85 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $165.11 / $364.32 / $364.32
| Professional | | $165.11 | $364.32 | $364.32 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $665.00 / $762.00 / $6,342.00
| Facility | | $665.00 | $762.00 | $6,342.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $149.03 / $350.16 / $412.47
| Professional | | $149.03 | $350.16 | $412.47 |