- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $50.20 / $1,000.00 / $2,812.00
| Facility | | $50.20 | $1,000.00 | $2,812.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $36.64 / $120.23 / $193.13
| Professional | | $36.64 | $120.23 | $193.13 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $42.72 / $62.82 / $252.72
| Professional | | $42.72 | $62.82 | $252.72 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $48.47 / $149.40 / $252.80
| Professional | | $48.47 | $149.40 | $252.80 |
- 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
- $140.66 / $179.67 / $304.45
| Professional | | $140.66 | $179.67 | $304.45 |