- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $495.46 / $495.46 / $8,500.00
| Facility | | $495.46 | $495.46 | $8,500.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $464.40 / $501.80 / $516.35
| Professional | | $464.40 | $501.80 | $516.35 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,023.11 / $1,125.47 / $1,319.68
| Professional | | $1,023.11 | $1,125.47 | $1,319.68 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $750.04 / $1,254.88 / $1,671.50
| Professional | | $750.04 | $1,254.88 | $1,671.50 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $495.46 / $749.16 / $870.25
| Facility | | $495.46 | $749.16 | $870.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $515.72 / $918.03 / $1,286.28
| Professional | | $515.72 | $918.03 | $1,286.28 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $515.72 / $912.82 / $1,286.28
| Professional | | $515.72 | $912.82 | $1,286.28 |