- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $39.81 / $44.67 / $1,096.48
| Facility | | $39.81 | $44.67 | $1,096.48 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $30.20 / $47.86 / $2,511.89
| Professional | | $30.20 | $47.86 | $2,511.89 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,202.26 / $1,698.24 / $2,511.89
| Professional | | $1,202.26 | $1,698.24 | $2,511.89 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $19.95 / $57.54 / $1,047.13
| Professional | | $19.95 | $57.54 | $1,047.13 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $288.40 / $575.44 / $3,388.44
| Professional | | $288.40 | $575.44 | $3,388.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $45.71 / $57.54 / $83.18
| Professional | | $45.71 | $57.54 | $83.18 |