- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $67.43 / $1,000.00 / $2,812.00
| Facility | | $67.43 | $1,000.00 | $2,812.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $55.38 / $95.12 / $207.87
| Professional | | $55.38 | $95.12 | $207.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $51.05 / $75.08 / $166.68
| Professional | | $51.05 | $75.08 | $166.68 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $60.18 / $107.74 / $244.52
| Professional | | $60.18 | $107.74 | $244.52 |
- 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
- $106.31 / $178.56 / $423.31
| Professional | | $106.31 | $178.56 | $423.31 |