- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $53.72 / $1,064.00 / $2,812.00
| Facility | | $53.72 | $1,064.00 | $2,812.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $28.53 / $58.43 / $76.14
| Professional | | $28.53 | $58.43 | $76.14 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $29.76 / $43.77 / $90.83
| Professional | | $29.76 | $43.77 | $90.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $27.71 / $50.10 / $104.60
| Professional | | $27.71 | $50.10 | $104.60 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $130.00 / $337.00 / $858.00
| Facility | | $130.00 | $337.00 | $858.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $64.05 / $75.83 / $128.08
| Professional | | $64.05 | $75.83 | $128.08 |