- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $364.74 / $520.28 / $8,500.00
| Facility | | $364.74 | $520.28 | $8,500.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $355.79 / $516.23 / $625.02
| Professional | | $355.79 | $516.23 | $625.02 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $741.03 / $959.02 / $1,227.64
| Professional | | $741.03 | $959.02 | $1,227.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $658.95 / $1,027.30 / $1,658.26
| Professional | | $658.95 | $1,027.30 | $1,658.26 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $364.74 / $532.76 / $1,094.22
| Facility | | $364.74 | $532.76 | $1,094.22 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $530.88 / $954.45 / $3,952.64
| Professional | | $530.88 | $954.45 | $3,952.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $530.88 / $782.92 / $1,122.92
| Professional | | $530.88 | $782.92 | $1,122.92 |