- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $202.16 / $315.43 / $457.37
| Facility | | $202.16 | $315.43 | $457.37 |
- 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
- $50.98 / $53.43 / $54.28
| Professional | | $50.98 | $53.43 | $54.28 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $52.89 / $81.22 / $155.56
| Facility | | $52.89 | $81.22 | $155.56 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2.48 / $3.10 / $450.00
| Professional | | $2.48 | $3.10 | $450.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $356.00 / $418.00 / $441.00
| Facility | | $356.00 | $418.00 | $441.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $40.24 / $74.20 / $150.00
| Professional | | $40.24 | $74.20 | $150.00 |