- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $270.64 / $425.48 / $5,000.00
| Facility | | $270.64 | $425.48 | $5,000.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $254.96 / $364.50 / $435.97
| Professional | | $254.96 | $364.50 | $435.97 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $537.85 / $696.08 / $1,016.28
| Professional | | $537.85 | $696.08 | $1,016.28 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $422.93 / $716.05 / $1,083.47
| Professional | | $422.93 | $716.05 | $1,083.47 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $270.64 / $425.48 / $705.80
| Facility | | $270.64 | $425.48 | $705.80 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $432.35 / $780.54 / $2,026.32
| Professional | | $432.35 | $780.54 | $2,026.32 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $432.35 / $773.35 / $1,113.36
| Professional | | $432.35 | $773.35 | $1,113.36 |