- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $320.02 / $513.83 / $5,000.00
| Facility | | $320.02 | $513.83 | $5,000.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $296.26 / $434.43 / $579.33
| Professional | | $296.26 | $434.43 | $579.33 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $715.39 / $925.84 / $1,363.20
| Professional | | $715.39 | $925.84 | $1,363.20 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $548.47 / $943.12 / $1,485.75
| Professional | | $548.47 | $943.12 | $1,485.75 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $320.02 / $513.83 / $960.09
| Facility | | $320.02 | $513.83 | $960.09 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $522.94 / $975.98 / $2,598.40
| Professional | | $522.94 | $975.98 | $2,598.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $532.95 / $935.57 / $1,344.01
| Professional | | $532.95 | $935.57 | $1,344.01 |