- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,995.26 / $5,011.87 / $12,022.64
| Facility | | $1,995.26 | $5,011.87 | $12,022.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $128.82 / $134.90 / $169.82
| Professional | | $128.82 | $134.90 | $169.82 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $346.74 / $478.63 / $1,174.90
| Facility | | $346.74 | $478.63 | $1,174.90 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $56.23 / $165.96 / $562.34
| Professional | | $56.23 | $165.96 | $562.34 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $794.33 / $2,137.96 / $6,606.93
| Facility | | $794.33 | $2,137.96 | $6,606.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $24.55 / $89.13 / $181.97
| Professional | | $24.55 | $89.13 | $181.97 |