- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $141.60 / $784.00 / $1,831.00
| Facility | | $141.60 | $784.00 | $1,831.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $106.33 / $151.47 / $293.44
| Professional | | $106.33 | $151.47 | $293.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $231.00 / $231.00 / $231.00
| Professional | | $231.00 | $231.00 | $231.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $122.34 / $197.13 / $305.27
| Professional | | $122.34 | $197.13 | $305.27 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $32.34 / $32.34 / $32.34
| Professional | | $32.34 | $32.34 | $32.34 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $225.00 / $529.00 / $1,739.00
| Facility | | $225.00 | $529.00 | $1,739.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $152.77 / $181.83 / $369.61
| Professional | | $152.77 | $181.83 | $369.61 |