- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $54.04 / $346.05 / $4,000.00
| Facility | | $54.04 | $346.05 | $4,000.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $25.78 / $28.87 / $112.25
| Professional | | $25.78 | $28.87 | $112.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $21.65 / $30.66 / $51.93
| Professional | | $21.65 | $30.66 | $51.93 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $19.32 / $29.05 / $62.38
| Facility | | $19.32 | $29.05 | $62.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $20.61 / $30.57 / $45.26
| Professional | | $20.61 | $30.57 | $45.26 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $16.88 / $32.34 / $32.92
| Professional | | $16.88 | $32.34 | $32.92 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $22.84 / $26.87 / $38.19
| Professional | | $22.84 | $26.87 | $38.19 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $27.30 / $36.47 / $49.14
| Professional | | $27.30 | $36.47 | $49.14 |