- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $579.04 / $3,706.14 / $3,955.04
| Facility | | $579.04 | $3,706.14 | $3,955.04 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $6.84 / $10.59 / $20.32
| Professional | | $6.84 | $10.59 | $20.32 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $7.62 / $12.76 / $19.46
| Professional | | $7.62 | $12.76 | $19.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $7.85 / $14.79 / $28.80
| Professional | | $7.85 | $14.79 | $28.80 |
- 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
- $11.21 / $20.00 / $28.83
| Professional | | $11.21 | $20.00 | $28.83 |