- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $43.65 / $45.71 / $56.23
| Professional | | $43.65 | $45.71 | $56.23 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $416.87 / $46,773.51 / $95,499.26
| Facility | | $416.87 | $46,773.51 | $95,499.26 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $144.54 / $144.54 / $1,000.00
| Facility | | $144.54 | $144.54 | $1,000.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $47.86 / $47.86 / $144.54
| Professional | | $47.86 | $47.86 | $144.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $251.19 / $295.12 / $660.69
| Facility | | $251.19 | $295.12 | $660.69 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $251.19 / $295.12 / $660.69
| Professional | | $251.19 | $295.12 | $660.69 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $144.54 / $144.54 / $1,000.00
| Facility | | $144.54 | $144.54 | $1,000.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $47.86 / $79.43 / $85.11
| Professional | | $47.86 | $79.43 | $85.11 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $46.77 / $46.77 / $46.77
| Professional | | $46.77 | $46.77 | $46.77 |