- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $61.66 / $100.00 / $218.78
| Facility | | $61.66 | $100.00 | $218.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $64.57 / $102.33 / $154.88
| Professional | | $64.57 | $102.33 | $154.88 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $30.20 / $85.11 / $114.82
| Professional | | $30.20 | $85.11 | $114.82 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $89.13 / $104.71 / $257.04
| Facility | | $89.13 | $104.71 | $257.04 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $100.00 / $102.33 / $104.71
| Professional | | $100.00 | $102.33 | $104.71 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $93.33 / $107.15 / $114.82
| Professional | | $93.33 | $107.15 | $114.82 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $47.86 / $114.82 / $416.87
| Facility | | $47.86 | $114.82 | $416.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $95.50 / $104.71 / $114.82
| Professional | | $95.50 | $104.71 | $114.82 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $114.82 / $186.21 / $302.00
| Facility | | $114.82 | $186.21 | $302.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $95.50 / $107.15 / $117.49
| Professional | | $95.50 | $107.15 | $117.49 |