- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $33.71 / $1,011.98 / $1,210.01
| Facility | | $33.71 | $1,011.98 | $1,210.01 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $34.42 / $1,071.52 / $1,361.67
| Professional | | $34.42 | $1,071.52 | $1,361.67 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $33.64 / $983.87 / $1,993.14
| Professional | | $33.64 | $983.87 | $1,993.14 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,077.57 / $1,077.57 / $1,077.57
| Professional | | $1,077.57 | $1,077.57 | $1,077.57 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $40.40 / $1,072.69 / $3,551.27
| Professional | | $40.40 | $1,072.69 | $3,551.27 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,319.12 / $1,844.22 / $2,970.00
| Professional | | $1,319.12 | $1,844.22 | $2,970.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $19.55 / $27.38 / $1,126.58
| Professional | | $19.55 | $27.38 | $1,126.58 |