- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $33.29 / $33.89 / $1,231.81
| Facility | | $33.29 | $33.89 | $1,231.81 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $28.81 / $976.84 / $1,302.45
| Professional | | $28.81 | $976.84 | $1,302.45 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $51.00 / $63.00 / $2,181.00
| Professional | | $51.00 | $63.00 | $2,181.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $37.50 / $1,077.57 / $1,210.97
| Professional | | $37.50 | $1,077.57 | $1,210.97 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,291.92 / $1,937.89 / $3,041.73
| Professional | | $1,291.92 | $1,937.89 | $3,041.73 |