- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $278.44 / $396.09 / $2,000.00
| Facility | | $278.44 | $396.09 | $2,000.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $265.56 / $346.45 / $396.09
| Professional | | $265.56 | $346.45 | $396.09 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $524.70 / $679.06 / $928.40
| Professional | | $524.70 | $679.06 | $928.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $394.12 / $700.86 / $1,203.58
| Professional | | $394.12 | $700.86 | $1,203.58 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $278.44 / $409.67 / $653.72
| Facility | | $278.44 | $409.67 | $653.72 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $402.04 / $728.44 / $1,956.08
| Professional | | $402.04 | $728.44 | $1,956.08 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $402.04 / $697.17 / $854.88
| Professional | | $402.04 | $697.17 | $854.88 |