- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $284.13 / $349.78 / $528.24
| Facility | | $284.13 | $349.78 | $528.24 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $75.00 / $135.62 / $3,798.96
| Professional | | $75.00 | $135.62 | $3,798.96 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $0.02 / $0.02 / $0.02
| Professional | | $0.02 | $0.02 | $0.02 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $128.65 / $192.70 / $373.66
| Facility | | $128.65 | $192.70 | $373.66 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $52.64 / $52.64 / $52.64
| Professional | | $52.64 | $52.64 | $52.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4,054.06 / $4,428.45 / $49,999.50
| Professional | | $4,054.06 | $4,428.45 | $49,999.50 |