- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $338.42 / $503.35 / $5,000.00
| Facility | | $338.42 | $503.35 | $5,000.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $296.01 / $423.48 / $544.65
| Professional | | $296.01 | $423.48 | $544.65 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $673.31 / $871.38 / $1,211.07
| Professional | | $673.31 | $871.38 | $1,211.07 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $509.56 / $894.85 / $1,525.35
| Professional | | $509.56 | $894.85 | $1,525.35 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $338.42 / $514.51 / $841.84
| Facility | | $338.42 | $514.51 | $841.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $512.83 / $905.20 / $2,532.56
| Professional | | $512.83 | $905.20 | $2,532.56 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $553.17 / $905.20 / $1,315.86
| Professional | | $553.17 | $905.20 | $1,315.86 |