- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $718.52 / $985.07 / $1,031.42
| Facility | | $718.52 | $985.07 | $1,031.42 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $105.00 / $795.00 / $1,031.42
| Professional | | $105.00 | $795.00 | $1,031.42 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $39.78 / $39.78 / $39.78
| Professional | | $39.78 | $39.78 | $39.78 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $218.46 / $218.46 / $240.31
| Facility | | $218.46 | $218.46 | $240.31 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $135.16 / $135.16 / $135.16
| Professional | | $135.16 | $135.16 | $135.16 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $750.60 / $750.60 / $750.60
| Professional | | $750.60 | $750.60 | $750.60 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $40.57 / $77.62 / $183.04
| Professional | | $40.57 | $77.62 | $183.04 |