- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $211.75 / $1,518.41 / $3,955.04
| Facility | | $211.75 | $1,518.41 | $3,955.04 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $35.61 / $59.95 / $97.52
| Professional | | $35.61 | $59.95 | $97.52 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $74.31 / $98.01 / $157.28
| Professional | | $74.31 | $98.01 | $157.28 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $55.06 / $111.13 / $184.24
| Professional | | $55.06 | $111.13 | $184.24 |
- 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
- $64.41 / $114.91 / $206.70
| Professional | | $64.41 | $114.91 | $206.70 |