- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $372.70 / $1,886.90 / $6,849.18
| Facility | | $372.70 | $1,886.90 | $6,849.18 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $264.64 / $293.39 / $415.38
| Professional | | $264.64 | $293.39 | $415.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $147.34 / $147.34 / $147.34
| Professional | | $147.34 | $147.34 | $147.34 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $30.00 / $45.00 / $60.00
| Professional | | $30.00 | $45.00 | $60.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $409.02 / $510.01 / $732.19
| Facility | | $409.02 | $510.01 | $732.19 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $242.40 / $242.40 / $242.40
| Professional | | $242.40 | $242.40 | $242.40 |