- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,450.44 / $2,450.44 / $6,907.00
| Facility | | $2,450.44 | $2,450.44 | $6,907.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $62.57 / $152.61 / $261.06
| Professional | | $62.57 | $152.61 | $261.06 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $552.29 / $552.29 / $1,404.00
| Facility | | $552.29 | $552.29 | $1,404.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $73.43 / $169.30 / $295.72
| Professional | | $73.43 | $169.30 | $295.72 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $414.00 / $1,320.00 / $1,320.00
| Facility | | $414.00 | $1,320.00 | $1,320.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $171.03 / $212.01 / $462.43
| Professional | | $171.03 | $212.01 | $462.43 |