- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $671.07 / $1,136.59 / $15,027.46
| Facility | | $671.07 | $1,136.59 | $15,027.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $256.44 / $417.18 / $670.31
| Professional | | $256.44 | $417.18 | $670.31 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $319.39 / $319.39 / $2,151.00
| Facility | | $319.39 | $319.39 | $2,151.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $245.01 / $373.89 / $596.80
| Professional | | $245.01 | $373.89 | $596.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,027.00 / $1,485.00 / $1,485.00
| Facility | | $1,027.00 | $1,485.00 | $1,485.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $318.10 / $411.65 / $911.13
| Professional | | $318.10 | $411.65 | $911.13 |