- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,238.72 / $3,162.28 / $4,570.88
| Facility | | $2,238.72 | $3,162.28 | $4,570.88 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $245.47 / $1,122.02 / $2,238.72
| Professional | | $245.47 | $1,122.02 | $2,238.72 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $338.84 / $1,288.25 / $2,187.76
| Professional | | $338.84 | $1,288.25 | $2,187.76 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $32.36 / $60.26 / $3,715.35
| Professional | | $32.36 | $60.26 | $3,715.35 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $346.74 / $851.14 / $4,265.80
| Professional | | $346.74 | $851.14 | $4,265.80 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $275.42 / $1,096.48 / $3,890.45
| Professional | | $275.42 | $1,096.48 | $3,890.45 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $346.74 / $1,698.24 / $2,570.40
| Professional | | $346.74 | $1,698.24 | $2,570.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,071.52 / $4,466.84 / $5,128.61
| Facility | | $1,071.52 | $4,466.84 | $5,128.61 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $257.04 / $1,096.48 / $2,290.87
| Professional | | $257.04 | $1,096.48 | $2,290.87 |