- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $903.68 / $1,518.41 / $3,955.04
| Facility | | $903.68 | $1,518.41 | $3,955.04 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $167.03 / $265.47 / $378.72
| Professional | | $167.03 | $265.47 | $378.72 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $186.88 / $358.81 / $509.69
| Professional | | $186.88 | $358.81 | $509.69 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $174.32 / $339.06 / $668.17
| Professional | | $174.32 | $339.06 | $668.17 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,654.00 / $3,447.00 / $7,350.00
| Facility | | $2,654.00 | $3,447.00 | $7,350.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $264.61 / $347.28 / $720.00
| Professional | | $264.61 | $347.28 | $720.00 |