- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $59.32 / $154.22 / $2,000.00
| Facility | | $59.32 | $154.22 | $2,000.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $53.66 / $131.10 / $158.40
| Professional | | $53.66 | $131.10 | $158.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $111.12 / $143.81 / $355.06
| Professional | | $111.12 | $143.81 | $355.06 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $96.36 / $180.98 / $484.19
| Professional | | $96.36 | $180.98 | $484.19 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $59.32 / $154.22 / $262.19
| Facility | | $59.32 | $154.22 | $262.19 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $155.91 / $271.10 / $549.32
| Professional | | $155.91 | $271.10 | $549.32 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $153.04 / $228.51 / $332.87
| Professional | | $153.04 | $228.51 | $332.87 |