- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $95.88 / $1,319.00 / $3,779.00
| Facility | | $95.88 | $1,319.00 | $3,779.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $64.29 / $149.72 / $290.93
| Professional | | $64.29 | $149.72 | $290.93 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $162.97 / $377.77 / $782.42
| Facility | | $162.97 | $377.77 | $782.42 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $87.08 / $121.41 / $282.75
| Professional | | $87.08 | $121.41 | $282.75 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $53.65 / $163.99 / $163.99
| Facility | | $53.65 | $163.99 | $163.99 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $69.31 / $160.13 / $302.89
| Professional | | $69.31 | $160.13 | $302.89 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $144.01 / $198.47 / $330.67
| Professional | | $144.01 | $198.47 | $330.67 |