- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $213.37 / $237.75 / $1,445.52
| Facility | | $213.37 | $237.75 | $1,445.52 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $237.75 / $237.75 / $265.18
| Professional | | $237.75 | $237.75 | $265.18 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,876.54 / $1,876.54 / $2,005.42
| Facility | | $1,876.54 | $1,876.54 | $2,005.42 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $304.81 / $304.81 / $416.83
| Professional | | $304.81 | $304.81 | $416.83 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $553.97 / $750.91 / $1,738.00
| Facility | | $553.97 | $750.91 | $1,738.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $138.31 / $178.31 / $359.60
| Professional | | $138.31 | $178.31 | $359.60 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $237.75 / $304.81 / $441.97
| Facility | | $237.75 | $304.81 | $441.97 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $167.65 / $167.65 / $167.65
| Professional | | $167.65 | $167.65 | $167.65 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $128.02 / $173.86 / $277.56
| Professional | | $128.02 | $173.86 | $277.56 |