- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $101.76 / $1,614.00 / $3,175.00
| Facility | | $101.76 | $1,614.00 | $3,175.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $37.03 / $101.76 / $227.53
| Professional | | $37.03 | $101.76 | $227.53 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $38.58 / $38.58 / $472.00
| Professional | | $38.58 | $38.58 | $472.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $37.84 / $93.42 / $444.54
| Professional | | $37.84 | $93.42 | $444.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $80.84 / $216.83 / $424.43
| Professional | | $80.84 | $216.83 | $424.43 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $165.00 / $442.00 / $5,940.00
| Facility | | $165.00 | $442.00 | $5,940.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $124.54 / $333.71 / $515.94
| Professional | | $124.54 | $333.71 | $515.94 |