- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $47.22 / $1,342.00 / $3,109.00
| Facility | | $47.22 | $1,342.00 | $3,109.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $39.61 / $47.22 / $56.19
| Professional | | $39.61 | $47.22 | $56.19 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $40.70 / $53.87 / $53.87
| Professional | | $40.70 | $53.87 | $53.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $47.20 / $66.65 / $100.00
| Professional | | $47.20 | $66.65 | $100.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $375.00 / $1,056.00 / $2,558.00
| Facility | | $375.00 | $1,056.00 | $2,558.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $38.43 / $51.87 / $84.52
| Professional | | $38.43 | $51.87 | $84.52 |