- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $315.33 / $498.30 / $5,000.00
| Facility | | $315.33 | $498.30 | $5,000.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $279.05 / $417.08 / $509.20
| Professional | | $279.05 | $417.08 | $509.20 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $630.57 / $836.61 / $1,199.47
| Professional | | $630.57 | $836.61 | $1,199.47 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $509.46 / $835.84 / $1,278.34
| Professional | | $509.46 | $835.84 | $1,278.34 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $315.33 / $498.30 / $832.73
| Facility | | $315.33 | $498.30 | $832.73 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $507.78 / $914.13 / $2,368.08
| Professional | | $507.78 | $914.13 | $2,368.08 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $507.78 / $914.13 / $1,302.84
| Professional | | $507.78 | $914.13 | $1,302.84 |