- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $352.35 / $352.35 / $806.55
| Facility | | $352.35 | $352.35 | $806.55 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $72.56 / $169.03 / $871.80
| Professional | | $72.56 | $169.03 | $871.80 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $153.00 / $184.00 / $362.00
| Professional | | $153.00 | $184.00 | $362.00 |
- Facility/Professional
- Professional
- Modifier
- 50
- Low / Median / High Price
- $229.50 / $276.00 / $543.00
| Professional | 50 | $229.50 | $276.00 | $543.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $105.14 / $181.28 / $391.23
| Professional | | $105.14 | $181.28 | $391.23 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,275.00 / $1,275.00 / $5,606.00
| Facility | | $1,275.00 | $1,275.00 | $5,606.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $266.19 / $532.39 / $638.87
| Professional | | $266.19 | $532.39 | $638.87 |