- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $184.46 / $936.00 / $2,010.00
| Facility | | $184.46 | $936.00 | $2,010.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $172.54 / $187.27 / $589.14
| Professional | | $172.54 | $187.27 | $589.14 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $414.00 / $414.00 / $414.00
| Professional | | $414.00 | $414.00 | $414.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $218.77 / $310.47 / $442.60
| Professional | | $218.77 | $310.47 | $442.60 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $32.34 / $32.34 / $32.34
| Professional | | $32.34 | $32.34 | $32.34 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $624.00 / $1,236.00 / $5,253.00
| Facility | | $624.00 | $1,236.00 | $5,253.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $184.37 / $276.05 / $520.26
| Professional | | $184.37 | $276.05 | $520.26 |