- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $187.68 / $1,518.41 / $3,955.04
| Facility | | $187.68 | $1,518.41 | $3,955.04 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $30.00 / $62.55 / $80.01
| Professional | | $30.00 | $62.55 | $80.01 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $31.72 / $61.94 / $120.62
| Professional | | $31.72 | $61.94 | $120.62 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $39.49 / $76.70 / $175.03
| Professional | | $39.49 | $76.70 | $175.03 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $540.00 / $1,401.00 / $4,915.00
| Facility | | $540.00 | $1,401.00 | $4,915.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $59.84 / $83.68 / $152.43
| Professional | | $59.84 | $83.68 | $152.43 |