- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $41.69 / $851.14 / $3,467.37
| Facility | | $41.69 | $851.14 | $3,467.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $30.20 / $47.86 / $97.72
| Professional | | $30.20 | $47.86 | $97.72 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $131.83 / $131.83 / $131.83
| Professional | | $131.83 | $131.83 | $131.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $11.48 / $23.44 / $138.04
| Professional | | $11.48 | $23.44 | $138.04 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $45.71 / $57.54 / $83.18
| Professional | | $45.71 | $57.54 | $83.18 |