- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $241.85 / $3,706.14 / $3,955.04
| Facility | | $241.85 | $3,706.14 | $3,955.04 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $40.86 / $48.28 / $68.80
| Professional | | $40.86 | $48.28 | $68.80 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $48.23 / $72.02 / $81.09
| Professional | | $48.23 | $72.02 | $81.09 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $34.74 / $59.35 / $122.22
| Professional | | $34.74 | $59.35 | $122.22 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $540.00 / $1,417.00 / $4,915.00
| Facility | | $540.00 | $1,417.00 | $4,915.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $42.78 / $60.35 / $90.79
| Professional | | $42.78 | $60.35 | $90.79 |