- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $281.84 / $446.68 / $1,000.00
| Facility | | $281.84 | $446.68 | $1,000.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $93.33 / $234.42 / $331.13
| Professional | | $93.33 | $234.42 | $331.13 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $257.04 / $281.84 / $851.14
| Facility | | $257.04 | $281.84 | $851.14 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $52.48 / $83.18 / $208.93
| Professional | | $52.48 | $83.18 | $208.93 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $162.18 / $162.18 / $354.81
| Facility | | $162.18 | $162.18 | $354.81 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $56.23 / $186.21 / $380.19
| Facility | | $56.23 | $186.21 | $380.19 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $54.95 / $131.83 / $407.38
| Professional | | $54.95 | $131.83 | $407.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $83.18 / $281.84 / $281.84
| Facility | | $83.18 | $281.84 | $281.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $74.13 / $120.23 / $269.15
| Professional | | $74.13 | $120.23 | $269.15 |