- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $103.37 / $1,000.00 / $4,164.24
| Facility | | $103.37 | $1,000.00 | $4,164.24 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $74.48 / $205.88 / $423.28
| Professional | | $74.48 | $205.88 | $423.28 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $86.46 / $127.15 / $421.94
| Professional | | $86.46 | $127.15 | $421.94 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $97.57 / $163.53 / $473.10
| Professional | | $97.57 | $163.53 | $473.10 |
- 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
- $241.37 / $377.19 / $574.74
| Professional | | $241.37 | $377.19 | $574.74 |