- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $446.68 / $812.83 / $1,513.56
| Facility | | $446.68 | $812.83 | $1,513.56 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $75.86 / $77.62 / $3,801.89
| Professional | | $75.86 | $77.62 | $3,801.89 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $549.54 / $1,071.52 / $1,096.48
| Professional | | $549.54 | $1,071.52 | $1,096.48 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $891.25 / $891.25 / $891.25
| Professional | | $891.25 | $891.25 | $891.25 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $66.07 / $218.78 / $380.19
| Facility | | $66.07 | $218.78 | $380.19 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $100,000.00 / $100,000.00 / $100,000.00
| Professional | | $100,000.00 | $100,000.00 | $100,000.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $173.78 / $851.14 / $1,380.38
| Facility | | $173.78 | $851.14 | $1,380.38 |