- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $602.56 / $851.14 / $1,000.00
| Facility | | $602.56 | $851.14 | $1,000.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $32.36 / $44.67 / $1,000.00
| Professional | | $32.36 | $44.67 | $1,000.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $389.05 / $588.84 / $977.24
| Professional | | $389.05 | $588.84 | $977.24 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $100.00 / $114.82 / $346.74
| Facility | | $100.00 | $114.82 | $346.74 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $416.87 / $660.69 / $1,000.00
| Professional | | $416.87 | $660.69 | $1,000.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $39.81 / $50.12 / $70.79
| Professional | | $39.81 | $50.12 | $70.79 |