- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $192.71 / $230.60 / $2,000.00
| Facility | | $192.71 | $230.60 | $2,000.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $148.55 / $200.31 / $246.45
| Professional | | $148.55 | $200.31 | $246.45 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $412.27 / $509.27 / $610.09
| Professional | | $412.27 | $509.27 | $610.09 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $257.66 / $518.96 / $685.69
| Professional | | $257.66 | $518.96 | $685.69 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $192.71 / $253.51 / $427.19
| Facility | | $192.71 | $253.51 | $427.19 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $221.84 / $366.14 / $1,508.40
| Professional | | $221.84 | $366.14 | $1,508.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $219.68 / $419.68 / $601.94
| Professional | | $219.68 | $419.68 | $601.94 |