- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $177.09 / $1,000.00 / $2,812.00
| Facility | | $177.09 | $1,000.00 | $2,812.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $94.60 / $158.10 / $236.80
| Professional | | $94.60 | $158.10 | $236.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $655.30 / $655.30 / $786.37
| Facility | | $655.30 | $655.30 | $786.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $112.05 / $164.78 / $241.73
| Professional | | $112.05 | $164.78 | $241.73 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $135.27 / $218.02 / $344.36
| Professional | | $135.27 | $218.02 | $344.36 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $330.00 / $811.00 / $2,285.00
| Facility | | $330.00 | $811.00 | $2,285.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $146.63 / $203.36 / $323.18
| Professional | | $146.63 | $203.36 | $323.18 |