- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,896.32 / $2,778.87 / $3,955.04
| Facility | | $1,896.32 | $2,778.87 | $3,955.04 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $222.02 / $295.67 / $377.80
| Professional | | $222.02 | $295.67 | $377.80 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $252.03 / $353.74 / $551.04
| Professional | | $252.03 | $353.74 | $551.04 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $289.07 / $477.84 / $801.00
| Professional | | $289.07 | $477.84 | $801.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $540.00 / $1,401.00 / $4,915.00
| Facility | | $540.00 | $1,401.00 | $4,915.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $300.72 / $499.58 / $726.83
| Professional | | $300.72 | $499.58 | $726.83 |