- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $560.52 / $1,543.03 / $3,955.04
| Facility | | $560.52 | $1,543.03 | $3,955.04 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $69.67 / $115.64 / $866.68
| Professional | | $69.67 | $115.64 | $866.68 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $104.30 / $437.48 / $835.69
| Professional | | $104.30 | $437.48 | $835.69 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $138.66 / $486.13 / $1,512.08
| Professional | | $138.66 | $486.13 | $1,512.08 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $540.00 / $1,183.00 / $4,915.00
| Facility | | $540.00 | $1,183.00 | $4,915.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $724.47 / $1,048.13 / $1,454.57
| Professional | | $724.47 | $1,048.13 | $1,454.57 |