- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,050.05 / $2,050.05 / $10,562.30
| Professional | | $2,050.05 | $2,050.05 | $10,562.30 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $278.22 / $1,092.38 / $1,820.28
| Facility | | $278.22 | $1,092.38 | $1,820.28 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,295.33 / $3,338.66 / $6,656.45
| Professional | | $2,295.33 | $3,338.66 | $6,656.45 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,700.00 / $1,700.00 / $1,700.00
| Professional | | $1,700.00 | $1,700.00 | $1,700.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $100.00 / $3,660.81 / $17,132.59
| Facility | | $100.00 | $3,660.81 | $17,132.59 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,256.35 / $2,783.31 / $4,576.72
| Professional | | $2,256.35 | $2,783.31 | $4,576.72 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,397.80 / $2,893.88 / $4,576.72
| Professional | | $2,397.80 | $2,893.88 | $4,576.72 |