- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $991.85 / $2,090.73 / $3,955.04
| Facility | | $991.85 | $2,090.73 | $3,955.04 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $32.82 / $51.10 / $91.89
| Professional | | $32.82 | $51.10 | $91.89 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $35.65 / $47.07 / $94.95
| Professional | | $35.65 | $47.07 | $94.95 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $46.54 / $72.23 / $94.79
| Professional | | $46.54 | $72.23 | $94.79 |
- 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
- $39.93 / $64.06 / $107.56
| Professional | | $39.93 | $64.06 | $107.56 |