- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $320.14 / $431.31 / $5,000.00
| Facility | | $320.14 | $431.31 | $5,000.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $311.14 / $364.93 / $462.55
| Professional | | $311.14 | $364.93 | $462.55 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $656.87 / $850.10 / $1,126.52
| Professional | | $656.87 | $850.10 | $1,126.52 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $464.96 / $864.45 / $1,402.98
| Professional | | $464.96 | $864.45 | $1,402.98 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $320.14 / $439.17 / $774.40
| Facility | | $320.14 | $439.17 | $774.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $442.46 / $836.90 / $2,465.84
| Professional | | $442.46 | $836.90 | $2,465.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $442.46 / $812.14 / $973.41
| Professional | | $442.46 | $812.14 | $973.41 |