- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $691.85 / $1,605.61 / $7,466.72
| Facility | | $691.85 | $1,605.61 | $7,466.72 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $691.85 / $979.03 / $1,109.56
| Professional | | $691.85 | $979.03 | $1,109.56 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,276.00 / $1,928.57 / $4,110.28
| Facility | | $1,276.00 | $1,928.57 | $4,110.28 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $913.76 / $1,710.03 / $2,378.38
| Professional | | $913.76 | $1,710.03 | $2,378.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $70.00 / $1,305.36 / $8,702.00
| Facility | | $70.00 | $1,305.36 | $8,702.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $548.26 / $783.22 / $1,331.48
| Professional | | $548.26 | $783.22 | $1,331.48 |