- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $30.20 / $741.31 / $776.25
| Facility | | $30.20 | $741.31 | $776.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $30.20 / $50.12 / $741.31
| Professional | | $30.20 | $50.12 | $741.31 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3.31 / $3.72 / $7.94
| Professional | | $3.31 | $3.72 | $7.94 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $275.42 / $436.52 / $602.56
| Professional | | $275.42 | $436.52 | $602.56 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $295.12 / $489.78 / $537.03
| Professional | | $295.12 | $489.78 | $537.03 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $45.71 / $67.61 / $100.00
| Professional | | $45.71 | $67.61 | $100.00 |