- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $135.85 / $1,000.00 / $2,812.00
| Facility | | $135.85 | $1,000.00 | $2,812.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $76.68 / $104.18 / $159.47
| Professional | | $76.68 | $104.18 | $159.47 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $89.23 / $131.22 / $176.37
| Professional | | $89.23 | $131.22 | $176.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $100.06 / $167.53 / $238.87
| Professional | | $100.06 | $167.53 | $238.87 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $130.00 / $328.00 / $768.00
| Facility | | $130.00 | $328.00 | $768.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $102.77 / $148.69 / $230.99
| Professional | | $102.77 | $148.69 | $230.99 |