- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,819.70 / $2,398.83 / $9,772.37
| Facility | | $1,819.70 | $2,398.83 | $9,772.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $128.82 / $223.87 / $831.76
| Professional | | $128.82 | $223.87 | $831.76 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $128.82 / $426.58 / $1,318.26
| Professional | | $128.82 | $426.58 | $1,318.26 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $295.12 / $1,047.13 / $1,905.46
| Professional | | $295.12 | $1,047.13 | $1,905.46 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,413.10 / $7,413.10 / $7,413.10
| Facility | | $7,413.10 | $7,413.10 | $7,413.10 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $154.88 / $630.96 / $1,445.44
| Professional | | $154.88 | $630.96 | $1,445.44 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,413.10 / $7,413.10 / $7,413.10
| Facility | | $7,413.10 | $7,413.10 | $7,413.10 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $194.98 / $812.83 / $2,041.74
| Professional | | $194.98 | $812.83 | $2,041.74 |