- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $105.65 / $177.10 / $2,000.00
| Facility | | $105.65 | $177.10 | $2,000.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $102.64 / $165.68 / $256.49
| Professional | | $102.64 | $165.68 | $256.49 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $214.35 / $281.07 / $468.35
| Professional | | $214.35 | $281.07 | $468.35 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $145.97 / $280.58 / $497.04
| Professional | | $145.97 | $280.58 | $497.04 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $105.65 / $177.10 / $327.64
| Facility | | $105.65 | $177.10 | $327.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $178.00 / $324.58 / $1,394.64
| Professional | | $178.00 | $324.58 | $1,394.64 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $125.00 / $125.00 / $125.00
| Facility | | $125.00 | $125.00 | $125.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $155.97 / $307.17 / $463.31
| Professional | | $155.97 | $307.17 | $463.31 |