- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $104.88 / $1,000.00 / $2,812.00
| Facility | | $104.88 | $1,000.00 | $2,812.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $83.56 / $110.68 / $138.19
| Professional | | $83.56 | $110.68 | $138.19 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $80.23 / $107.26 / $141.96
| Professional | | $80.23 | $107.26 | $141.96 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $88.67 / $135.44 / $182.29
| Professional | | $88.67 | $135.44 | $182.29 |
- 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
- $88.65 / $103.58 / $200.12
| Professional | | $88.65 | $103.58 | $200.12 |