- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $302.00 / $3,235.94 / $6,760.83
| Facility | | $302.00 | $3,235.94 | $6,760.83 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,137.96 / $2,137.96 / $2,137.96
| Facility | | $2,137.96 | $2,137.96 | $2,137.96 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $165.96 / $354.81 / $758.58
| Professional | | $165.96 | $354.81 | $758.58 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $208.93 / $416.87 / $5,011.87
| Facility | | $208.93 | $416.87 | $5,011.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $346.74 / $446.68 / $478.63
| Professional | | $346.74 | $446.68 | $478.63 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,137.96 / $2,137.96 / $2,137.96
| Facility | | $2,137.96 | $2,137.96 | $2,137.96 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,511.89 / $4,786.30 / $6,309.57
| Facility | | $2,511.89 | $4,786.30 | $6,309.57 |