- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $37.86 / $1,064.00 / $2,812.00
| Facility | | $37.86 | $1,064.00 | $2,812.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $21.10 / $28.42 / $37.86
| Professional | | $21.10 | $28.42 | $37.86 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $24.98 / $33.07 / $42.98
| Professional | | $24.98 | $33.07 | $42.98 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $20.34 / $33.19 / $53.00
| Professional | | $20.34 | $33.19 | $53.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $130.00 / $328.00 / $858.00
| Facility | | $130.00 | $328.00 | $858.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $31.17 / $37.40 / $62.59
| Professional | | $31.17 | $37.40 | $62.59 |