- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $223.87 / $1,513.56 / $2,041.74
| Facility | | $223.87 | $1,513.56 | $2,041.74 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $173.78 / $208.93 / $346.74
| Professional | | $173.78 | $208.93 | $346.74 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,884.03 / $2,884.03 / $3,981.07
| Facility | | $2,884.03 | $2,884.03 | $3,981.07 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $213.80 / $213.80 / $281.84
| Professional | | $213.80 | $213.80 | $281.84 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $512.86 / $691.83 / $2,511.89
| Facility | | $512.86 | $691.83 | $2,511.89 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $186.21 / $251.19 / $354.81
| Professional | | $186.21 | $251.19 | $354.81 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $812.83 / $1,819.70 / $7,079.46
| Facility | | $812.83 | $1,819.70 | $7,079.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $169.82 / $229.09 / $346.74
| Professional | | $169.82 | $229.09 | $346.74 |