- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $510.94 / $1,220.88 / $2,549.32
| Facility | | $510.94 | $1,220.88 | $2,549.32 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $510.94 / $979.27 / $2,549.32
| Professional | | $510.94 | $979.27 | $2,549.32 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $730.86 / $730.86 / $730.86
| Professional | | $730.86 | $730.86 | $730.86 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,000.00 / $1,000.00 / $1,000.00
| Facility | | $1,000.00 | $1,000.00 | $1,000.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $555.01 / $909.32 / $1,408.50
| Professional | | $555.01 | $909.32 | $1,408.50 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $32.34 / $32.34 / $32.34
| Professional | | $32.34 | $32.34 | $32.34 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $690.00 / $1,236.00 / $8,817.00
| Facility | | $690.00 | $1,236.00 | $8,817.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $551.10 / $731.95 / $1,507.61
| Professional | | $551.10 | $731.95 | $1,507.61 |