- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $126.83 / $2,761.00 / $3,175.00
| Facility | | $126.83 | $2,761.00 | $3,175.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $54.60 / $89.58 / $118.32
| Professional | | $54.60 | $89.58 | $118.32 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $48.86 / $61.57 / $284.00
| Professional | | $48.86 | $61.57 | $284.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $54.36 / $107.12 / $267.43
| Professional | | $54.36 | $107.12 | $267.43 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $100.01 / $105.27 / $224.23
| Professional | | $100.01 | $105.27 | $224.23 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $665.00 / $762.00 / $6,342.00
| Facility | | $665.00 | $762.00 | $6,342.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $85.25 / $123.68 / $272.58
| Professional | | $85.25 | $123.68 | $272.58 |