- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $343.10 / $534.37 / $8,500.00
| Facility | | $343.10 | $534.37 | $8,500.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $328.44 / $468.86 / $534.37
| Professional | | $328.44 | $468.86 | $534.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $702.24 / $908.82 / $1,274.82
| Professional | | $702.24 | $908.82 | $1,274.82 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $593.11 / $1,036.45 / $1,417.81
| Professional | | $593.11 | $1,036.45 | $1,417.81 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $343.10 / $534.37 / $1,029.30
| Facility | | $343.10 | $534.37 | $1,029.30 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $556.86 / $983.29 / $4,006.24
| Professional | | $556.86 | $983.29 | $4,006.24 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $549.41 / $668.23 / $1,092.54
| Professional | | $549.41 | $668.23 | $1,092.54 |