- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $175.58 / $257.87 / $2,000.00
| Facility | | $175.58 | $257.87 | $2,000.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $171.40 / $228.81 / $292.74
| Professional | | $171.40 | $228.81 | $292.74 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $358.35 / $486.48 / $656.73
| Professional | | $358.35 | $486.48 | $656.73 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $220.66 / $445.58 / $686.55
| Professional | | $220.66 | $445.58 | $686.55 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $175.58 / $269.35 / $526.74
| Facility | | $175.58 | $269.35 | $526.74 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $246.51 / $473.06 / $2,401.00
| Professional | | $246.51 | $473.06 | $2,401.00 |
- 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
- $236.38 / $470.11 / $595.45
| Professional | | $236.38 | $470.11 | $595.45 |