- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $34.61 / $101.38 / $8,500.00
| Facility | | $34.61 | $101.38 | $8,500.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $26.51 / $58.54 / $165.01
| Professional | | $26.51 | $58.54 | $165.01 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $66.41 / $145.13 / $228.20
| Professional | | $66.41 | $145.13 | $228.20 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $58.65 / $108.42 / $313.30
| Professional | | $58.65 | $108.42 | $313.30 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $34.61 / $97.92 / $172.35
| Facility | | $34.61 | $97.92 | $172.35 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $100.52 / $177.25 / $745.84
| Professional | | $100.52 | $177.25 | $745.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $100.52 / $167.40 / $218.81
| Professional | | $100.52 | $167.40 | $218.81 |