- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $67.61 / $1,000.00 / $2,041.74
| Facility | | $67.61 | $1,000.00 | $2,041.74 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $40.74 / $58.88 / $147.91
| Professional | | $40.74 | $58.88 | $147.91 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $20.42 / $41.69 / $74.13
| Professional | | $20.42 | $41.69 | $74.13 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $70.79 / $81.28 / $190.55
| Professional | | $70.79 | $81.28 | $190.55 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $46.77 / $77.62 / $104.71
| Professional | | $46.77 | $77.62 | $104.71 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $128.82 / $331.13 / $851.14
| Facility | | $128.82 | $331.13 | $851.14 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $39.81 / $64.57 / $107.15
| Professional | | $39.81 | $64.57 | $107.15 |