- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $309.03 / $2,454.71 / $7,585.78
| Facility | | $309.03 | $2,454.71 | $7,585.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,047.13 / $1,047.13 / $1,047.13
| Professional | | $1,047.13 | $1,047.13 | $1,047.13 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $223.87 / $2,884.03 / $3,801.89
| Facility | | $223.87 | $2,884.03 | $3,801.89 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $64.57 / $354.81 / $467.74
| Professional | | $64.57 | $354.81 | $467.74 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $831.76 / $1,202.26 / $4,897.79
| Facility | | $831.76 | $1,202.26 | $4,897.79 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $602.56 / $616.60 / $616.60
| Professional | | $602.56 | $616.60 | $616.60 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,230.27 / $1,288.25 / $2,398.83
| Facility | | $1,230.27 | $1,288.25 | $2,398.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,137.96 / $3,090.30 / $5,888.44
| Professional | | $2,137.96 | $3,090.30 | $5,888.44 |