- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $145.65 / $374.82 / $2,000.00
| Facility | | $145.65 | $374.82 | $2,000.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $129.65 / $341.18 / $463.94
| Professional | | $129.65 | $341.18 | $463.94 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $290.63 / $516.09 / $885.30
| Professional | | $290.63 | $516.09 | $885.30 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $242.42 / $473.53 / $1,107.61
| Professional | | $242.42 | $473.53 | $1,107.61 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $145.65 / $374.82 / $630.28
| Facility | | $145.65 | $374.82 | $630.28 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $418.02 / $688.19 / $1,339.89
| Professional | | $418.02 | $688.19 | $1,339.89 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $380.02 / $657.69 / $836.04
| Professional | | $380.02 | $657.69 | $836.04 |