- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $602.67 / $723.21 / $723.21
| Facility | | $602.67 | $723.21 | $723.21 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $361.61 / $361.61 / $361.61
| Professional | | $361.61 | $361.61 | $361.61 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $650.89 / $2,712.04 / $13,017.78
| Facility | | $650.89 | $2,712.04 | $13,017.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $578.57 / $650.89 / $119,998.80
| Professional | | $578.57 | $650.89 | $119,998.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $391.74 / $578.57 / $1,446.29
| Facility | | $391.74 | $578.57 | $1,446.29 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,323.91 / $2,323.91 / $2,323.91
| Professional | | $2,323.91 | $2,323.91 | $2,323.91 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $202.50 / $202.50 / $202.50
| Facility | | $202.50 | $202.50 | $202.50 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $87.07 / $103.66 / $300.60
| Professional | | $87.07 | $103.66 | $300.60 |