- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $602.56 / $1,995.26 / $8,317.64
| Facility | | $602.56 | $1,995.26 | $8,317.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $588.84 / $602.56 / $812.83
| Professional | | $588.84 | $602.56 | $812.83 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $363.08 / $870.96 / $1,513.56
| Facility | | $363.08 | $870.96 | $1,513.56 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $616.60 / $691.83 / $1,000.00
| Professional | | $616.60 | $691.83 | $1,000.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $660.69 / $660.69 / $1,202.26
| Facility | | $660.69 | $660.69 | $1,202.26 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $660.69 / $660.69 / $660.69
| Professional | | $660.69 | $660.69 | $660.69 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $831.76 / $933.25 / $1,698.24
| Facility | | $831.76 | $933.25 | $1,698.24 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $645.65 / $645.65 / $831.76
| Professional | | $645.65 | $645.65 | $831.76 |