- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $36.31 / $251.19 / $676.08
| Professional | | $36.31 | $251.19 | $676.08 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $75.86 / $100.00 / $239.88
| Professional | | $75.86 | $100.00 | $239.88 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,041.74 / $2,041.74 / $2,041.74
| Professional | | $2,041.74 | $2,041.74 | $2,041.74 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $36.31 / $295.12 / $562.34
| Facility | | $36.31 | $295.12 | $562.34 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $40.74 / $69.18 / $107.15
| Professional | | $40.74 | $69.18 | $107.15 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,238.72 / $2,238.72 / $2,238.72
| Facility | | $2,238.72 | $2,238.72 | $2,238.72 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,238.72 / $3,388.44 / $3,388.44
| Professional | | $2,238.72 | $3,388.44 | $3,388.44 |