- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $224.97 / $3,038.00 / $4,387.00
| Facility | | $224.97 | $3,038.00 | $4,387.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $224.97 / $247.46 / $1,213.80
| Professional | | $224.97 | $247.46 | $1,213.80 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $30.00 / $45.00 / $60.00
| Professional | | $30.00 | $45.00 | $60.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,109.24 / $1,322.98 / $1,683.01
| Professional | | $1,109.24 | $1,322.98 | $1,683.01 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,312.00 / $2,446.00 / $13,847.00
| Facility | | $2,312.00 | $2,446.00 | $13,847.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $981.07 / $1,285.53 / $2,131.29
| Professional | | $981.07 | $1,285.53 | $2,131.29 |