- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,047.13 / $2,137.96 / $7,762.47
| Facility | | $1,047.13 | $2,137.96 | $7,762.47 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $524.81 / $524.81 / $524.81
| Professional | | $524.81 | $524.81 | $524.81 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $758.58 / $1,659.59 / $2,754.23
| Facility | | $758.58 | $1,659.59 | $2,754.23 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $50.12 / $85.11 / $3,467.37
| Professional | | $50.12 | $85.11 | $3,467.37 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $562.34 / $4,265.80 / $10,000.00
| Facility | | $562.34 | $4,265.80 | $10,000.00 |