- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $406.14 / $1,520.00 / $3,728.00
| Facility | | $406.14 | $1,520.00 | $3,728.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $323.37 / $356.26 / $406.14
| Professional | | $323.37 | $356.26 | $406.14 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,852.08 / $4,952.74 / $7,166.20
| Facility | | $2,852.08 | $4,952.74 | $7,166.20 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $400.00 / $400.00 / $400.00
| Facility | | $400.00 | $400.00 | $400.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $882.00 / $3,474.00 / $9,160.00
| Facility | | $882.00 | $3,474.00 | $9,160.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $326.00 / $435.39 / $760.71
| Professional | | $326.00 | $435.39 | $760.71 |