- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $96.25 / $2,095.00 / $7,838.38
| Facility | | $96.25 | $2,095.00 | $7,838.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $96.25 / $99.46 / $163.36
| Professional | | $96.25 | $99.46 | $163.36 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $50.00 / $85.00 / $149.38
| Professional | | $50.00 | $85.00 | $149.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $53.29 / $103.78 / $163.36
| Facility | | $53.29 | $103.78 | $163.36 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $60.00 / $127.90 / $205.68
| Professional | | $60.00 | $127.90 | $205.68 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $230.00 / $1,158.00 / $1,401.00
| Facility | | $230.00 | $1,158.00 | $1,401.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $112.48 / $141.53 / $203.27
| Professional | | $112.48 | $141.53 | $203.27 |