- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $85.37 / $121.46 / $2,000.00
| Facility | | $85.37 | $121.46 | $2,000.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $80.98 / $110.14 / $140.57
| Professional | | $80.98 | $110.14 | $140.57 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $157.13 / $202.70 / $253.59
| Professional | | $157.13 | $202.70 | $253.59 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $105.82 / $190.82 / $284.37
| Professional | | $105.82 | $190.82 | $284.37 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $85.37 / $122.65 / $239.39
| Facility | | $85.37 | $122.65 | $239.39 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $120.26 / $229.07 / $819.52
| Professional | | $120.26 | $229.07 | $819.52 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $125.00 / $125.00 / $125.00
| Facility | | $125.00 | $125.00 | $125.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $106.65 / $207.53 / $315.36
| Professional | | $106.65 | $207.53 | $315.36 |