- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,513.56 / $1,548.82 / $3,981.07
| Facility | | $1,513.56 | $1,548.82 | $3,981.07 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $112.20 / $128.82 / $186.21
| Professional | | $112.20 | $128.82 | $186.21 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $0.02 / $245.47 / $288.40
| Professional | | $0.02 | $245.47 | $288.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $676.08 / $1,230.27 / $1,230.27
| Facility | | $676.08 | $1,230.27 | $1,230.27 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $120.23 / $199.53 / $389.05
| Professional | | $120.23 | $199.53 | $389.05 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $794.33 / $2,398.83 / $5,495.41
| Facility | | $794.33 | $2,398.83 | $5,495.41 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $104.71 / $147.91 / $269.15
| Professional | | $104.71 | $147.91 | $269.15 |