- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,140.00 / $3,140.00 / $6,907.00
| Facility | | $3,140.00 | $3,140.00 | $6,907.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $307.32 / $449.48 / $576.13
| Professional | | $307.32 | $449.48 | $576.13 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $354.53 / $354.53 / $2,151.00
| Facility | | $354.53 | $354.53 | $2,151.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $265.56 / $409.44 / $684.01
| Professional | | $265.56 | $409.44 | $684.01 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,027.00 / $1,485.00 / $1,485.00
| Facility | | $1,027.00 | $1,485.00 | $1,485.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $333.56 / $421.88 / $1,031.51
| Professional | | $333.56 | $421.88 | $1,031.51 |