- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $456.00 / $722.00 / $3,290.80
| Facility | | $456.00 | $722.00 | $3,290.80 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $456.00 / $516.79 / $684.00
| Professional | | $456.00 | $516.79 | $684.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $381.69 / $534.38 / $2,857.96
| Facility | | $381.69 | $534.38 | $2,857.96 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $925.90 / $925.90 / $1,109.33
| Professional | | $925.90 | $925.90 | $1,109.33 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $456.00 / $456.00 / $646.00
| Professional | | $456.00 | $456.00 | $646.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $760.00 / $760.00 / $1,140.00
| Facility | | $760.00 | $760.00 | $1,140.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $266.00 / $319.20 / $1,022.96
| Professional | | $266.00 | $319.20 | $1,022.96 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $456.00 / $456.00 / $456.00
| Professional | | $456.00 | $456.00 | $456.00 |