- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $425.00 / $1,527.00 / $3,206.00
| Facility | | $425.00 | $1,527.00 | $3,206.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $370.50 / $425.00 / $475.00
| Professional | | $370.50 | $425.00 | $475.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $294.80 / $352.75 / $445.98
| Facility | | $294.80 | $352.75 | $445.98 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $238.84 / $328.24 / $822.00
| Facility | | $238.84 | $328.24 | $822.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $100.00 / $345.40 / $345.40
| Professional | | $100.00 | $345.40 | $345.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $100.00 / $100.00 / $100.00
| Facility | | $100.00 | $100.00 | $100.00 |