- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,960.65 / $2,248.21 / $2,326.64
| Facility | | $1,960.65 | $2,248.21 | $2,326.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,899.77 / $2,248.21 / $2,326.64
| Professional | | $1,899.77 | $2,248.21 | $2,326.64 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $0.02 / $0.03 / $0.03
| Facility | | $0.02 | $0.03 | $0.03 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,865.64 / $2,027.87 / $2,027.87
| Professional | | $1,865.64 | $2,027.87 | $2,027.87 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,950.00 / $1,950.00 / $2,601.66
| Facility | | $1,950.00 | $1,950.00 | $2,601.66 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $244.82 / $1,950.00 / $3,611.25
| Professional | | $244.82 | $1,950.00 | $3,611.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $835.55 / $1,310.17 / $1,984.43
| Professional | | $835.55 | $1,310.17 | $1,984.43 |