- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,379.86 / $2,444.46 / $8,655.12
| Facility | | $1,379.86 | $2,444.46 | $8,655.12 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $119.53 / $264.24 / $1,060.18
| Professional | | $119.53 | $264.24 | $1,060.18 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $176.33 / $688.89 / $1,125.41
| Professional | | $176.33 | $688.89 | $1,125.41 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $169.47 / $351.02 / $2,011.78
| Professional | | $169.47 | $351.02 | $2,011.78 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,395.00 / $2,384.00 / $5,510.00
| Facility | | $1,395.00 | $2,384.00 | $5,510.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $907.09 / $1,423.22 / $2,122.23
| Professional | | $907.09 | $1,423.22 | $2,122.23 |