- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $189.68 / $1,518.41 / $3,955.04
| Facility | | $189.68 | $1,518.41 | $3,955.04 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $29.46 / $38.65 / $52.39
| Professional | | $29.46 | $38.65 | $52.39 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $32.59 / $46.55 / $62.87
| Professional | | $32.59 | $46.55 | $62.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $32.61 / $55.97 / $79.53
| Professional | | $32.61 | $55.97 | $79.53 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $540.00 / $1,183.00 / $4,915.00
| Facility | | $540.00 | $1,183.00 | $4,915.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $34.94 / $49.60 / $79.72
| Professional | | $34.94 | $49.60 | $79.72 |