- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $872.98 / $989.37 / $4,500.00
| Facility | | $872.98 | $989.37 | $4,500.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $29.78 / $1,033.22 / $1,377.62
| Professional | | $29.78 | $1,033.22 | $1,377.62 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,790.19 / $2,790.19 / $4,283.91
| Facility | | $2,790.19 | $2,790.19 | $4,283.91 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $41.58 / $176.78 / $1,741.16
| Professional | | $41.58 | $176.78 | $1,741.16 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,077.57 / $1,077.57 / $1,077.57
| Professional | | $1,077.57 | $1,077.57 | $1,077.57 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,047.57 / $1,396.76 / $2,033.01
| Professional | | $1,047.57 | $1,396.76 | $2,033.01 |