- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $612.00 / $2,500.00 / $7,367.00
| Facility | | $612.00 | $2,500.00 | $7,367.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $473.66 / $517.41 / $589.86
| Professional | | $473.66 | $517.41 | $589.86 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,562.61 / $6,560.64 / $11,588.58
| Facility | | $3,562.61 | $6,560.64 | $11,588.58 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $882.00 / $3,238.00 / $8,257.00
| Facility | | $882.00 | $3,238.00 | $8,257.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $498.11 / $793.71 / $1,147.23
| Professional | | $498.11 | $793.71 | $1,147.23 |