- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $585.74 / $585.74 / $3,550.00
| Facility | | $585.74 | $585.74 | $3,550.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $459.03 / $585.74 / $669.63
| Professional | | $459.03 | $585.74 | $669.63 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,064.78 / $9,140.95 / $18,801.72
| Facility | | $2,064.78 | $9,140.95 | $18,801.72 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $119,998.80 / $119,998.80 / $119,998.80
| Professional | | $119,998.80 | $119,998.80 | $119,998.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $661.51 / $661.51 / $661.51
| Facility | | $661.51 | $661.51 | $661.51 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,754.92 / $2,754.92 / $2,754.92
| Professional | | $2,754.92 | $2,754.92 | $2,754.92 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $490.12 / $704.55 / $1,148.42
| Professional | | $490.12 | $704.55 | $1,148.42 |