- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $186.26 / $218.38 / $2,000.00
| Facility | | $186.26 | $218.38 | $2,000.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $164.12 / $193.32 / $228.54
| Professional | | $164.12 | $193.32 | $228.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $375.73 / $450.40 / $543.20
| Professional | | $375.73 | $450.40 | $543.20 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $284.88 / $484.40 / $714.15
| Professional | | $284.88 | $484.40 | $714.15 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $186.26 / $247.31 / $394.47
| Facility | | $186.26 | $247.31 | $394.47 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $223.39 / $401.36 / $1,238.72
| Professional | | $223.39 | $401.36 | $1,238.72 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $223.39 / $395.40 / $491.46
| Professional | | $223.39 | $395.40 | $491.46 |