- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,258.93 / $2,511.89 / $4,466.84
| Facility | | $1,258.93 | $2,511.89 | $4,466.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $173.78 / $407.38 / $977.24
| Professional | | $173.78 | $407.38 | $977.24 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $158.49 / $263.03 / $602.56
| Professional | | $158.49 | $263.03 | $602.56 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $218.78 / $489.78 / $1,023.29
| Professional | | $218.78 | $489.78 | $1,023.29 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,570.40 / $4,677.35 / $7,585.78
| Facility | | $2,570.40 | $4,677.35 | $7,585.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $309.03 / $549.54 / $1,047.13
| Professional | | $309.03 | $549.54 | $1,047.13 |