- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $59.81 / $2,000.00 / $2,703.13
| Facility | | $59.81 | $2,000.00 | $2,703.13 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $53.10 / $88.23 / $266.11
| Professional | | $53.10 | $88.23 | $266.11 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $116.38 / $184.65 / $240.19
| Professional | | $116.38 | $184.65 | $240.19 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $83.73 / $158.03 / $294.31
| Professional | | $83.73 | $158.03 | $294.31 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $59.81 / $90.49 / $271.47
| Facility | | $59.81 | $90.49 | $271.47 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $93.83 / $163.40 / $235.20
| Professional | | $93.83 | $163.40 | $235.20 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $89.87 / $166.08 / $235.20
| Professional | | $89.87 | $166.08 | $235.20 |