- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $794.33 / $2,570.40 / $6,606.93
| Facility | | $794.33 | $2,570.40 | $6,606.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $239.88 / $380.19 / $676.08
| Professional | | $239.88 | $380.19 | $676.08 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,570.40 / $2,570.40 / $2,570.40
| Facility | | $2,570.40 | $2,570.40 | $2,570.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $295.12 / $416.87 / $588.84
| Professional | | $295.12 | $416.87 | $588.84 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $281.84 / $549.54 / $4,786.30
| Facility | | $281.84 | $549.54 | $4,786.30 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $371.54 / $489.78 / $2,884.03
| Professional | | $371.54 | $489.78 | $2,884.03 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $891.25 / $3,235.94 / $6,025.60
| Facility | | $891.25 | $3,235.94 | $6,025.60 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $245.47 / $363.08 / $537.03
| Professional | | $245.47 | $363.08 | $537.03 |