- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $478.53 / $1,051.49 / $2,990.82
| Facility | | $478.53 | $1,051.49 | $2,990.82 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $299.08 / $299.08 / $346.08
| Professional | | $299.08 | $299.08 | $346.08 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $702.84 / $781.03 / $1,666.31
| Facility | | $702.84 | $781.03 | $1,666.31 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $170.90 / $277.70 / $277.70
| Professional | | $170.90 | $277.70 | $277.70 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $771.51 / $1,562.13 / $1,874.33
| Facility | | $771.51 | $1,562.13 | $1,874.33 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $427.26 / $620.13 / $1,407.44
| Professional | | $427.26 | $620.13 | $1,407.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $179.45 / $256.36 / $256.36
| Professional | | $179.45 | $256.36 | $256.36 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $319.04 / $372.64 / $2,500.00
| Professional | | $319.04 | $372.64 | $2,500.00 |