- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $20.74 / $1,550.00 / $2,139.55
| Facility | | $20.74 | $1,550.00 | $2,139.55 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $97.63 / $105.80 / $105.80
| Professional | | $97.63 | $105.80 | $105.80 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $95.01 / $117.56 / $375.41
| Professional | | $95.01 | $117.56 | $375.41 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $235.18 / $476.03 / $476.38
| Facility | | $235.18 | $476.03 | $476.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $90.41 / $321.10 / $494.97
| Professional | | $90.41 | $321.10 | $494.97 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $113.18 / $135.52 / $256.51
| Professional | | $113.18 | $135.52 | $256.51 |