- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $532.85 / $2,124.32 / $2,130.57
| Facility | | $532.85 | $2,124.32 | $2,130.57 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $407.72 / $461.88 / $533.91
| Professional | | $407.72 | $461.88 | $533.91 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $252.34 / $724.94 / $1,028.76
| Professional | | $252.34 | $724.94 | $1,028.76 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $30.00 / $45.00 / $80.00
| Professional | | $30.00 | $45.00 | $80.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $437.82 / $595.13 / $867.27
| Facility | | $437.82 | $595.13 | $867.27 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $521.65 / $655.20 / $819.37
| Professional | | $521.65 | $655.20 | $819.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $402.08 / $568.66 / $790.21
| Professional | | $402.08 | $568.66 | $790.21 |