- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $247.22 / $3,038.00 / $4,387.00
| Facility | | $247.22 | $3,038.00 | $4,387.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $182.88 / $247.22 / $267.49
| Professional | | $182.88 | $247.22 | $267.49 |
- 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
- $176.48 / $195.64 / $326.16
| Facility | | $176.48 | $195.64 | $326.16 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $141.66 / $187.56 / $327.06
| Professional | | $141.66 | $187.56 | $327.06 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $159.78 / $198.65 / $423.60
| Professional | | $159.78 | $198.65 | $423.60 |