- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $58.88 / $562.34 / $1,995.26
| Facility | | $58.88 | $562.34 | $1,995.26 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $52.48 / $177.83 / $630.96
| Professional | | $52.48 | $177.83 | $630.96 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $54.95 / $54.95 / $54.95
| Professional | | $54.95 | $54.95 | $54.95 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $831.76 / $831.76 / $1,000.00
| Facility | | $831.76 | $831.76 | $1,000.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $100.00 / $100.00 / $100.00
| Professional | | $100.00 | $100.00 | $100.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $323.59 / $323.59 / $954.99
| Facility | | $323.59 | $323.59 | $954.99 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $58.88 / $128.82 / $645.65
| Professional | | $58.88 | $128.82 | $645.65 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $32.36 / $32.36 / $33.11
| Professional | | $32.36 | $32.36 | $33.11 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $478.63 / $977.24 / $1,862.09
| Facility | | $478.63 | $977.24 | $1,862.09 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $52.48 / $316.23 / $794.33
| Professional | | $52.48 | $316.23 | $794.33 |