- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $315.43 / $378.52 / $681.33
| Facility | | $315.43 | $378.52 | $681.33 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $315.43 / $315.43 / $455.00
| Professional | | $315.43 | $315.43 | $455.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $309.36 / $309.36 / $309.36
| Professional | | $309.36 | $309.36 | $309.36 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $45.64 / $66.20 / $172.68
| Facility | | $45.64 | $66.20 | $172.68 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2.48 / $2.50 / $3.15
| Professional | | $2.48 | $2.50 | $3.15 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $252.70 / $315.43 / $455.00
| Facility | | $252.70 | $315.43 | $455.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $350.00 / $350.00 / $350.00
| Professional | | $350.00 | $350.00 | $350.00 |