- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $100.00 / $151.36 / $208.93
| Facility | | $100.00 | $151.36 | $208.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $93.33 / $100.00 / $141.25
| Professional | | $93.33 | $100.00 | $141.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $70.79 / $79.43 / $93.33
| Professional | | $70.79 | $79.43 | $93.33 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $109.65 / $114.82 / $114.82
| Facility | | $109.65 | $114.82 | $114.82 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $85.11 / $100.00 / $100.00
| Professional | | $85.11 | $100.00 | $100.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $36.31 / $37.15 / $57.54
| Facility | | $36.31 | $37.15 | $57.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $35.48 / $38.02 / $46.77
| Professional | | $35.48 | $38.02 | $46.77 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $107.15 / $181.97 / $181.97
| Facility | | $107.15 | $181.97 | $181.97 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $107.15 / $512.86 / $512.86
| Professional | | $107.15 | $512.86 | $512.86 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $95.50 / $114.82 / $117.49
| Professional | | $95.50 | $114.82 | $117.49 |