- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $646.00 / $1,520.00 / $3,728.00
| Facility | | $646.00 | $1,520.00 | $3,728.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,186.61 / $1,231.03 / $1,403.37
| Professional | | $1,186.61 | $1,231.03 | $1,403.37 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,636.82 / $8,052.01 / $11,650.59
| Facility | | $4,636.82 | $8,052.01 | $11,650.59 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $746.00 / $2,415.00 / $6,585.00
| Facility | | $746.00 | $2,415.00 | $6,585.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,124.18 / $1,658.83 / $2,437.71
| Professional | | $1,124.18 | $1,658.83 | $2,437.71 |