- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $330.47 / $1,788.48 / $5,817.26
| Facility | | $330.47 | $1,788.48 | $5,817.26 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $111.40 / $379.44 / $695.91
| Professional | | $111.40 | $379.44 | $695.91 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $119.69 / $333.01 / $929.86
| Professional | | $119.69 | $333.01 | $929.86 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,860.92 / $1,860.92 / $1,860.92
| Facility | | $1,860.92 | $1,860.92 | $1,860.92 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $174.51 / $174.51 / $184.11
| Professional | | $174.51 | $174.51 | $184.11 |
- Facility/Professional
- Professional
- Modifier
- 50
- Low / Median / High Price
- $791.82 / $791.82 / $791.82
| Professional | 50 | $791.82 | $791.82 | $791.82 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $470.08 / $626.09 / $1,346.08
| Professional | | $470.08 | $626.09 | $1,346.08 |