- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $39.81 / $1,047.13 / $1,548.82
| Facility | | $39.81 | $1,047.13 | $1,548.82 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $32.36 / $42.66 / $2,344.23
| Professional | | $32.36 | $42.66 | $2,344.23 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $954.99 / $1,258.93 / $1,584.89
| Professional | | $954.99 | $1,258.93 | $1,584.89 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,000.00 / $1,380.38 / $1,862.09
| Professional | | $1,000.00 | $1,380.38 | $1,862.09 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $39.81 / $39.81 / $81.28
| Facility | | $39.81 | $39.81 | $81.28 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $46.77 / $52.48 / $5,888.44
| Professional | | $46.77 | $52.48 | $5,888.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $44.67 / $50.12 / $64.57
| Professional | | $44.67 | $50.12 | $64.57 |