- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,513.56 / $1,548.82 / $3,981.07
| Facility | | $1,513.56 | $1,548.82 | $3,981.07 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $75.86 / $131.83 / $1,258.93
| Professional | | $75.86 | $131.83 | $1,258.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $58.88 / $77.62 / $138.04
| Professional | | $58.88 | $77.62 | $138.04 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $79.43 / $123.03 / $165.96
| Professional | | $79.43 | $123.03 | $165.96 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,659.59 / $3,548.13 / $7,244.36
| Facility | | $1,659.59 | $3,548.13 | $7,244.36 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $66.07 / $107.15 / $154.88
| Professional | | $66.07 | $107.15 | $154.88 |