- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $575.44 / $1,445.44 / $1,862.09
| Facility | | $575.44 | $1,445.44 | $1,862.09 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $38.90 / $75.86 / $138.04
| Professional | | $38.90 | $75.86 | $138.04 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $100.00 / $117.49 / $158.49
| Facility | | $100.00 | $117.49 | $158.49 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $29.51 / $52.48 / $87.10
| Professional | | $29.51 | $52.48 | $87.10 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $39.81 / $72.44 / $186.21
| Professional | | $39.81 | $72.44 | $186.21 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $218.78 / $562.34 / $1,548.82
| Facility | | $218.78 | $562.34 | $1,548.82 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $34.67 / $58.88 / $100.00
| Professional | | $34.67 | $58.88 | $100.00 |