- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $102.51 / $106.61 / $145.88
| Facility | | $102.51 | $106.61 | $145.88 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $105.08 / $112.16 / $33,907.19
| Professional | | $105.08 | $112.16 | $33,907.19 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $250.00 / $285.31 / $285.31
| Professional | | $250.00 | $285.31 | $285.31 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $196.59 / $285.89 / $508.93
| Facility | | $196.59 | $285.89 | $508.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $226.08 / $275.23 / $698.74
| Professional | | $226.08 | $275.23 | $698.74 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $358.74 / $482.61 / $482.61
| Facility | | $358.74 | $482.61 | $482.61 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $309.64 / $470.76 / $1,080.45
| Professional | | $309.64 | $470.76 | $1,080.45 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $100.00 / $100.00 / $100.00
| Professional | | $100.00 | $100.00 | $100.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $100.04 / $235.32 / $376.21
| Professional | | $100.04 | $235.32 | $376.21 |