- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $616.60 / $3,162.28 / $9,549.93
| Facility | | $616.60 | $3,162.28 | $9,549.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $309.03 / $354.81 / $891.25
| Professional | | $309.03 | $354.81 | $891.25 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,584.89 / $4,265.80 / $10,000.00
| Facility | | $1,584.89 | $4,265.80 | $10,000.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $263.03 / $416.87 / $812.83
| Professional | | $263.03 | $416.87 | $812.83 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $588.84 / $1,318.26 / $3,162.28
| Facility | | $588.84 | $1,318.26 | $3,162.28 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $316.23 / $512.86 / $1,122.02
| Professional | | $316.23 | $512.86 | $1,122.02 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,584.89 / $4,265.80 / $10,000.00
| Facility | | $1,584.89 | $4,265.80 | $10,000.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $281.84 / $398.11 / $758.58
| Professional | | $281.84 | $398.11 | $758.58 |