- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $26.66 / $137.36 / $2,072.73
| Facility | | $26.66 | $137.36 | $2,072.73 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $18.91 / $24.31 / $33.00
| Professional | | $18.91 | $24.31 | $33.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $18.20 / $31.71 / $42.17
| Professional | | $18.20 | $31.71 | $42.17 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $51.13 / $52.87 / $60.00
| Professional | | $51.13 | $52.87 | $60.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $27.48 / $31.17 / $36.34
| Professional | | $27.48 | $31.17 | $36.34 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $20.59 / $23.43 / $36.20
| Professional | | $20.59 | $23.43 | $36.20 |