- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,235.94 / $5,248.07 / $7,244.36
| Facility | | $3,235.94 | $5,248.07 | $7,244.36 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $181.97 / $251.19 / $436.52
| Professional | | $181.97 | $251.19 | $436.52 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $302.00 / $302.00 / $302.00
| Facility | | $302.00 | $302.00 | $302.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $173.78 / $251.19 / $457.09
| Professional | | $173.78 | $251.19 | $457.09 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $104.71 / $144.54 / $501.19
| Facility | | $104.71 | $144.54 | $501.19 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $162.18 / $223.87 / $331.13
| Professional | | $162.18 | $223.87 | $331.13 |