- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,308.96 / $2,699.40 / $3,706.14
| Facility | | $1,308.96 | $2,699.40 | $3,706.14 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $59.98 / $1,033.76 / $1,764.20
| Professional | | $59.98 | $1,033.76 | $1,764.20 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $97.18 / $218.80 / $1,202.78
| Professional | | $97.18 | $218.80 | $1,202.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $105.86 / $226.86 / $2,420.16
| Professional | | $105.86 | $226.86 | $2,420.16 |
- 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
- $1,165.15 / $1,677.57 / $2,183.98
| Professional | | $1,165.15 | $1,677.57 | $2,183.98 |