- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $50.12 / $1,288.25 / $2,454.71
| Facility | | $50.12 | $1,288.25 | $2,454.71 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $32.36 / $39.81 / $51.29
| Professional | | $32.36 | $39.81 | $51.29 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $46.77 / $66.07 / $100.00
| Professional | | $46.77 | $66.07 | $100.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $371.54 / $1,071.52 / $2,570.40
| Facility | | $371.54 | $1,071.52 | $2,570.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $35.48 / $44.67 / $79.43
| Professional | | $35.48 | $44.67 | $79.43 |