- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $501.19 / $3,388.44 / $6,760.83
| Facility | | $501.19 | $3,388.44 | $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
- $275.42 / $562.34 / $1,380.38
| Professional | | $275.42 | $562.34 | $1,380.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $346.74 / $691.83 / $5,011.87
| Facility | | $346.74 | $691.83 | $5,011.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $575.44 / $724.44 / $794.33
| Professional | | $575.44 | $724.44 | $794.33 |
- 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 |