- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $616.38 / $3,685.50 / $8,064.50
| Facility | | $616.38 | $3,685.50 | $8,064.50 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $322.39 / $357.75 / $557.38
| Professional | | $322.39 | $357.75 | $557.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,402.00 / $4,634.53 / $9,678.00
| Facility | | $2,402.00 | $4,634.53 | $9,678.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $324.36 / $472.30 / $671.86
| Professional | | $324.36 | $472.30 | $671.86 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $515.00 / $1,089.00 / $2,935.00
| Facility | | $515.00 | $1,089.00 | $2,935.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $338.54 / $504.00 / $821.31
| Professional | | $338.54 | $504.00 | $821.31 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,559.50 / $4,299.00 / $8,976.50
| Facility | | $1,559.50 | $4,299.00 | $8,976.50 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $315.48 / $477.27 / $774.37
| Professional | | $315.48 | $477.27 | $774.37 |