- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,090.73 / $3,706.14 / $9,424.41
| Facility | | $2,090.73 | $3,706.14 | $9,424.41 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $176.31 / $419.94 / $1,470.61
| Professional | | $176.31 | $419.94 | $1,470.61 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,641.52 / $1,885.31 / $2,758.11
| Facility | | $1,641.52 | $1,885.31 | $2,758.11 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $323.31 / $622.62 / $1,733.52
| Professional | | $323.31 | $622.62 | $1,733.52 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $279.52 / $540.25 / $1,775.54
| Professional | | $279.52 | $540.25 | $1,775.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $540.00 / $1,401.00 / $4,915.00
| Facility | | $540.00 | $1,401.00 | $4,915.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $288.94 / $1,230.75 / $1,854.55
| Professional | | $288.94 | $1,230.75 | $1,854.55 |