- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $57.55 / $1,821.00 / $9,477.00
| Facility | | $57.55 | $1,821.00 | $9,477.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $27.27 / $64.70 / $112.37
| Professional | | $27.27 | $64.70 | $112.37 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $257.91 / $257.91 / $257.91
| Facility | | $257.91 | $257.91 | $257.91 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $130.00 / $328.00 / $768.00
| Facility | | $130.00 | $328.00 | $768.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $92.80 / $137.74 / $206.50
| Professional | | $92.80 | $137.74 | $206.50 |