- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $105.01 / $144.71 / $2,000.00
| Facility | | $105.01 | $144.71 | $2,000.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $98.45 / $125.81 / $244.90
| Professional | | $98.45 | $125.81 | $244.90 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $212.38 / $274.86 / $382.97
| Professional | | $212.38 | $274.86 | $382.97 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $150.82 / $267.29 / $473.71
| Professional | | $150.82 | $267.29 | $473.71 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $105.01 / $173.90 / $258.61
| Facility | | $105.01 | $173.90 | $258.61 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $151.22 / $265.47 / $778.32
| Professional | | $151.22 | $265.47 | $778.32 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $153.31 / $261.70 / $312.33
| Professional | | $153.31 | $261.70 | $312.33 |