- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $94.44 / $1,000.00 / $2,812.00
| Facility | | $94.44 | $1,000.00 | $2,812.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $71.56 / $97.90 / $138.65
| Professional | | $71.56 | $97.90 | $138.65 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $70.01 / $102.96 / $156.43
| Professional | | $70.01 | $102.96 | $156.43 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $81.61 / $129.96 / $220.38
| Professional | | $81.61 | $129.96 | $220.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $130.00 / $337.00 / $858.00
| Facility | | $130.00 | $337.00 | $858.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $97.02 / $141.35 / $488.00
| Professional | | $97.02 | $141.35 | $488.00 |