- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $107.47 / $1,000.00 / $3,373.00
| Facility | | $107.47 | $1,000.00 | $3,373.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $102.52 / $127.53 / $167.79
| Professional | | $102.52 | $127.53 | $167.79 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $144.82 / $252.28 / $367.01
| Facility | | $144.82 | $252.28 | $367.01 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $109.85 / $111.71 / $128.93
| Professional | | $109.85 | $111.71 | $128.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $88.53 / $88.53 / $88.53
| Professional | | $88.53 | $88.53 | $88.53 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $104.79 / $159.68 / $239.63
| Professional | | $104.79 | $159.68 | $239.63 |