- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $133.51 / $163.11 / $8,500.00
| Facility | | $133.51 | $163.11 | $8,500.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $119.84 / $156.09 / $464.58
| Professional | | $119.84 | $156.09 | $464.58 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $264.33 / $332.40 / $420.95
| Professional | | $264.33 | $332.40 | $420.95 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $179.05 / $318.99 / $512.66
| Professional | | $179.05 | $318.99 | $512.66 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $133.51 / $185.91 / $400.53
| Facility | | $133.51 | $185.91 | $400.53 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $169.98 / $299.23 / $422.99
| Professional | | $169.98 | $299.23 | $422.99 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $166.32 / $299.23 / $422.99
| Professional | | $166.32 | $299.23 | $422.99 |