- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $156.12 / $265.47 / $2,000.00
| Facility | | $156.12 | $265.47 | $2,000.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $148.13 / $224.56 / $277.30
| Professional | | $148.13 | $224.56 | $277.30 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $309.69 / $420.42 / $666.46
| Professional | | $309.69 | $420.42 | $666.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $230.01 / $415.54 / $703.54
| Professional | | $230.01 | $415.54 | $703.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $156.12 / $265.47 / $458.12
| Facility | | $156.12 | $265.47 | $458.12 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $270.67 / $494.97 / $1,161.76
| Professional | | $270.67 | $494.97 | $1,161.76 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $270.67 / $474.48 / $572.96
| Professional | | $270.67 | $474.48 | $572.96 |