- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $75.86 / $128.82 / $676.08
| Facility | | $75.86 | $128.82 | $676.08 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $72.44 / $549.54 / $1,047.13
| Professional | | $72.44 | $549.54 | $1,047.13 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $199.53 / $234.42 / $1,230.27
| Professional | | $199.53 | $234.42 | $1,230.27 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $61.66 / $204.17 / $1,230.27
| Facility | | $61.66 | $204.17 | $1,230.27 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,000.00 / $1,737.80 / $3,630.78
| Professional | | $1,000.00 | $1,737.80 | $3,630.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $91.20 / $1,380.38 / $2,238.72
| Professional | | $91.20 | $1,380.38 | $2,238.72 |