- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $536.01 / $970.08 / $2,250.00
| Facility | | $536.01 | $970.08 | $2,250.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $292.89 / $536.01 / $970.08
| Professional | | $292.89 | $536.01 | $970.08 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,548.13 / $1,874.14 / $2,521.32
| Facility | | $1,548.13 | $1,874.14 | $2,521.32 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $375.47 / $577.75 / $997.73
| Professional | | $375.47 | $577.75 | $997.73 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $340.40 / $540.64 / $1,352.36
| Professional | | $340.40 | $540.64 | $1,352.36 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $834.00 / $2,891.00 / $4,402.00
| Facility | | $834.00 | $2,891.00 | $4,402.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $482.34 / $587.34 / $1,089.40
| Professional | | $482.34 | $587.34 | $1,089.40 |