- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $57.07 / $1,468.00 / $2,126.41
| Facility | | $57.07 | $1,468.00 | $2,126.41 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $44.59 / $44.59 / $2,126.41
| Professional | | $44.59 | $44.59 | $2,126.41 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $343.67 / $343.67 / $343.67
| Professional | | $343.67 | $343.67 | $343.67 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $44.59 / $47.27 / $63.76
| Facility | | $44.59 | $47.27 | $63.76 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $30.00 / $55.00 / $3,900.00
| Professional | | $30.00 | $55.00 | $3,900.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,002.20 / $1,447.29 / $1,946.13
| Facility | | $1,002.20 | $1,447.29 | $1,946.13 |