- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $446.68 / $7,244.36 / $16,595.87
| Facility | | $446.68 | $7,244.36 | $16,595.87 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $741.31 / $1,380.38 / $3,388.44
| Facility | | $741.31 | $1,380.38 | $3,388.44 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $263.03 / $575.44 / $1,412.54
| Facility | | $263.03 | $575.44 | $1,412.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $269.15 / $269.15 / $302.00
| Professional | | $269.15 | $269.15 | $302.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $162.18 / $251.19 / $524.81
| Facility | | $162.18 | $251.19 | $524.81 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $616.60 / $6,309.57 / $10,000.00
| Facility | | $616.60 | $6,309.57 | $10,000.00 |