- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $456.32 / $1,002.69 / $2,852.01
| Facility | | $456.32 | $1,002.69 | $2,852.01 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $115.86 / $115.86 / $134.06
| Professional | | $115.86 | $115.86 | $134.06 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $670.22 / $744.78 / $1,588.98
| Facility | | $670.22 | $744.78 | $1,588.98 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $225.10 / $264.82 / $264.83
| Professional | | $225.10 | $264.82 | $264.83 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $735.70 / $1,489.11 / $1,787.34
| Facility | | $735.70 | $1,489.11 | $1,787.34 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $407.43 / $552.96 / $1,222.46
| Professional | | $407.43 | $552.96 | $1,222.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $69.51 / $99.31 / $244.46
| Professional | | $69.51 | $99.31 | $244.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,500.00 / $2,750.00 / $3,500.00
| Professional | | $2,500.00 | $2,750.00 | $3,500.00 |