- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $338.00 / $1,300.00 / $3,500.00
| Facility | | $338.00 | $1,300.00 | $3,500.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $140.83 / $150.07 / $250.28
| Professional | | $140.83 | $150.07 | $250.28 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $611.80 / $1,048.23 / $1,472.39
| Facility | | $611.80 | $1,048.23 | $1,472.39 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $194.00 / $543.00 / $1,560.00
| Facility | | $194.00 | $543.00 | $1,560.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $143.63 / $195.70 / $405.07
| Professional | | $143.63 | $195.70 | $405.07 |