- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $100.00 / $213.80 / $1,778.28
| Facility | | $100.00 | $213.80 | $1,778.28 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $100.00 / $102.33 / $120.23
| Professional | | $100.00 | $102.33 | $120.23 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $69.18 / $109.65 / $131.83
| Professional | | $69.18 | $109.65 | $131.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $123.03 / $144.54 / $190.55
| Professional | | $123.03 | $144.54 | $190.55 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $95.50 / $100.00 / $100.00
| Facility | | $95.50 | $100.00 | $100.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $100.00 / $100.00 / $114.82
| Professional | | $100.00 | $100.00 | $114.82 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $100.00 / $144.54 / $316.23
| Facility | | $100.00 | $144.54 | $316.23 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $89.13 / $97.72 / $467.74
| Professional | | $89.13 | $97.72 | $467.74 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $141.25 / $141.25 / $165.96
| Facility | | $141.25 | $141.25 | $165.96 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $104.71 / $125.89 / $165.96
| Professional | | $104.71 | $125.89 | $165.96 |