- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,299.00 / $1,670.23 / $5,078.59
| Facility | | $1,299.00 | $1,670.23 | $5,078.59 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,227.04 / $1,227.04 / $1,507.00
| Professional | | $1,227.04 | $1,227.04 | $1,507.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $8.01 / $8.01 / $9.61
| Professional | | $8.01 | $8.01 | $9.61 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $650.16 / $802.37 / $1,194.94
| Facility | | $650.16 | $802.37 | $1,194.94 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $30.00 / $30.00 / $30.00
| Professional | | $30.00 | $30.00 | $30.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $584.00 / $597.16 / $634.54
| Facility | | $584.00 | $597.16 | $634.54 |