- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $792.88 / $7,492.54 / $47,719.40
| Facility | | $792.88 | $7,492.54 | $47,719.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $695.17 / $726.24 / $797.75
| Professional | | $695.17 | $726.24 | $797.75 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $714.95 / $944.42 / $1,368.22
| Professional | | $714.95 | $944.42 | $1,368.22 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,000.00 / $2,000.00 / $2,000.00
| Facility | | $2,000.00 | $2,000.00 | $2,000.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $741.02 / $891.91 / $1,753.83
| Professional | | $741.02 | $891.91 | $1,753.83 |