- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $336.43 / $2,922.00 / $4,387.00
| Facility | | $336.43 | $2,922.00 | $4,387.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $71.41 / $314.02 / $357.51
| Professional | | $71.41 | $314.02 | $357.51 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1.32 / $45.00 / $60.00
| Professional | | $1.32 | $45.00 | $60.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $47.92 / $378.32 / $507.45
| Professional | | $47.92 | $378.32 | $507.45 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,078.00 / $1,556.00 / $4,495.00
| Facility | | $1,078.00 | $1,556.00 | $4,495.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $70.79 / $377.40 / $662.99
| Professional | | $70.79 | $377.40 | $662.99 |