- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $79.02 / $2,922.00 / $4,387.00
| Facility | | $79.02 | $2,922.00 | $4,387.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $74.86 / $80.31 / $85.49
| Professional | | $74.86 | $80.31 | $85.49 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $30.00 / $30.00 / $60.00
| Professional | | $30.00 | $30.00 | $60.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $103.48 / $114.71 / $147.01
| Facility | | $103.48 | $114.71 | $147.01 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $83.07 / $92.30 / $104.54
| Professional | | $83.07 | $92.30 | $104.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $81.94 / $86.98 / $140.30
| Professional | | $81.94 | $86.98 | $140.30 |