- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $58.10 / $1,000.00 / $2,812.00
| Facility | | $58.10 | $1,000.00 | $2,812.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $46.85 / $124.66 / $226.59
| Professional | | $46.85 | $124.66 | $226.59 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $47.49 / $69.84 / $293.26
| Professional | | $47.49 | $69.84 | $293.26 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $53.96 / $182.04 / $322.58
| Professional | | $53.96 | $182.04 | $322.58 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $130.00 / $337.00 / $768.00
| Facility | | $130.00 | $337.00 | $768.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $162.26 / $239.29 / $396.45
| Professional | | $162.26 | $239.29 | $396.45 |