- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $540.28 / $1,543.03 / $3,955.04
| Facility | | $540.28 | $1,543.03 | $3,955.04 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $24.44 / $41.95 / $53.75
| Professional | | $24.44 | $41.95 | $53.75 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $23.54 / $47.54 / $82.24
| Professional | | $23.54 | $47.54 | $82.24 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $28.82 / $55.80 / $115.98
| Professional | | $28.82 | $55.80 | $115.98 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $540.00 / $1,401.00 / $4,915.00
| Facility | | $540.00 | $1,401.00 | $4,915.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $43.58 / $64.23 / $103.08
| Professional | | $43.58 | $64.23 | $103.08 |