- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $42.66 / $102.33 / $114.82
| Facility | | $42.66 | $102.33 | $114.82 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $39.81 / $47.86 / $72.44
| Professional | | $39.81 | $47.86 | $72.44 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $109.65 / $151.36 / $1,621.81
| Facility | | $109.65 | $151.36 | $1,621.81 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $53.70 / $70.79 / $107.15
| Professional | | $53.70 | $70.79 | $107.15 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $47.86 / $63.10 / $100.00
| Professional | | $47.86 | $63.10 | $100.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $54.95 / $1,288.25 / $1,288.25
| Facility | | $54.95 | $1,288.25 | $1,288.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $371.54 / $436.52 / $436.52
| Professional | | $371.54 | $436.52 | $436.52 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $295.12 / $812.83 / $2,511.89
| Facility | | $295.12 | $812.83 | $2,511.89 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $46.77 / $67.61 / $100.00
| Professional | | $46.77 | $67.61 | $100.00 |