- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,089.30 / $4,570.88 / $8,511.38
| Facility | | $2,089.30 | $4,570.88 | $8,511.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $147.91 / $177.83 / $316.23
| Professional | | $147.91 | $177.83 | $316.23 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $151.36 / $302.00 / $371.54
| Professional | | $151.36 | $302.00 | $371.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $204.17 / $281.84 / $416.87
| Professional | | $204.17 | $281.84 | $416.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $263.03 / $263.03 / $295.12
| Professional | | $263.03 | $263.03 | $295.12 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,288.25 / $3,890.45 / $6,760.83
| Facility | | $1,288.25 | $3,890.45 | $6,760.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $165.96 / $245.47 / $489.78
| Professional | | $165.96 | $245.47 | $489.78 |