- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $480.96 / $480.96 / $1,951.75
| Facility | | $480.96 | $480.96 | $1,951.75 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $152.51 / $832.20 / $916.27
| Professional | | $152.51 | $832.20 | $916.27 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $270.00 / $394.00 / $2,226.00
| Professional | | $270.00 | $394.00 | $2,226.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $209.02 / $359.58 / $2,238.62
| Professional | | $209.02 | $359.58 | $2,238.62 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,275.00 / $1,275.00 / $5,606.00
| Facility | | $1,275.00 | $1,275.00 | $5,606.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,555.41 / $3,061.83 / $3,732.95
| Professional | | $1,555.41 | $3,061.83 | $3,732.95 |