- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $512.86 / $602.56 / $2,290.87
| Facility | | $512.86 | $602.56 | $2,290.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $512.86 / $602.56 / $954.99
| Professional | | $512.86 | $602.56 | $954.99 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $562.34 / $562.34 / $676.08
| Facility | | $562.34 | $562.34 | $676.08 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $602.56 / $602.56 / $602.56
| Professional | | $602.56 | $602.56 | $602.56 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $912.01 / $912.01 / $2,290.87
| Facility | | $912.01 | $912.01 | $2,290.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $537.03 / $812.83 / $3,019.95
| Professional | | $537.03 | $812.83 | $3,019.95 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,454.71 / $2,454.71 / $9,332.54
| Facility | | $2,454.71 | $2,454.71 | $9,332.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $446.68 / $676.08 / $1,000.00
| Professional | | $446.68 | $676.08 | $1,000.00 |