- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $501.19 / $524.81 / $691.83
| Facility | | $501.19 | $524.81 | $691.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $30.20 / $47.86 / $977.24
| Professional | | $30.20 | $47.86 | $977.24 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $363.08 / $691.83 / $1,445.44
| Professional | | $363.08 | $691.83 | $1,445.44 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $524.81 / $524.81 / $676.08
| Facility | | $524.81 | $524.81 | $676.08 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $44.67 / $602.56 / $1,000.00
| Professional | | $44.67 | $602.56 | $1,000.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $354.81 / $645.65 / $1,445.44
| Professional | | $354.81 | $645.65 | $1,445.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $41.69 / $53.70 / $79.43
| Professional | | $41.69 | $53.70 | $79.43 |