- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $36.31 / $57.54 / $89.13
| Facility | | $36.31 | $57.54 | $89.13 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $34.67 / $52.48 / $107.15
| Professional | | $34.67 | $52.48 | $107.15 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $47.86 / $100.00 / $151.36
| Professional | | $47.86 | $100.00 | $151.36 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,258.93 / $3,311.31 / $4,786.30
| Facility | | $1,258.93 | $3,311.31 | $4,786.30 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $44.67 / $58.88 / $223.87
| Professional | | $44.67 | $58.88 | $223.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $39.81 / $54.95 / $83.18
| Professional | | $39.81 | $54.95 | $83.18 |