- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $630.96 / $1,513.56 / $2,570.40
| Facility | | $630.96 | $1,513.56 | $2,570.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $501.19 / $575.44 / $1,230.27
| Professional | | $501.19 | $575.44 | $1,230.27 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,041.74 / $2,041.74 / $2,041.74
| Facility | | $2,041.74 | $2,041.74 | $2,041.74 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,258.93 / $1,258.93 / $1,621.81
| Professional | | $1,258.93 | $1,258.93 | $1,621.81 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,621.81 / $1,819.70 / $7,413.10
| Facility | | $1,621.81 | $1,819.70 | $7,413.10 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $588.84 / $870.96 / $1,148.15
| Professional | | $588.84 | $870.96 | $1,148.15 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $32.36 / $32.36 / $33.11
| Professional | | $32.36 | $32.36 | $33.11 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,174.90 / $5,248.07 / $10,000.00
| Facility | | $1,174.90 | $5,248.07 | $10,000.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $489.78 / $630.96 / $1,258.93
| Professional | | $489.78 | $630.96 | $1,258.93 |