- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $170.50 / $1,083.00 / $2,812.00
| Facility | | $170.50 | $1,083.00 | $2,812.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $57.57 / $135.36 / $170.50
| Professional | | $57.57 | $135.36 | $170.50 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $51.79 / $76.16 / $185.31
| Professional | | $51.79 | $76.16 | $185.31 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $93.85 / $182.48 / $287.70
| Professional | | $93.85 | $182.48 | $287.70 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $130.00 / $328.00 / $858.00
| Facility | | $130.00 | $328.00 | $858.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $150.40 / $172.87 / $299.80
| Professional | | $150.40 | $172.87 | $299.80 |