- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $184.48 / $347.25 / $5,000.00
| Facility | | $184.48 | $347.25 | $5,000.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $178.44 / $294.70 / $347.25
| Professional | | $178.44 | $294.70 | $347.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $366.90 / $485.59 / $822.30
| Professional | | $366.90 | $485.59 | $822.30 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $311.52 / $580.17 / $1,044.33
| Professional | | $311.52 | $580.17 | $1,044.33 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $184.48 / $347.25 / $576.42
| Facility | | $184.48 | $347.25 | $576.42 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $376.41 / $637.03 / $1,385.44
| Professional | | $376.41 | $637.03 | $1,385.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $351.15 / $634.27 / $910.49
| Professional | | $351.15 | $634.27 | $910.49 |