- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $223.87 / $2,570.40 / $7,943.28
| Facility | | $223.87 | $2,570.40 | $7,943.28 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,090.30 / $3,981.07 / $4,466.84
| Facility | | $3,090.30 | $3,981.07 | $4,466.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $128.82 / $162.18 / $407.38
| Professional | | $128.82 | $162.18 | $407.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $223.87 / $288.40 / $354.81
| Professional | | $223.87 | $288.40 | $354.81 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $144.54 / $213.80 / $331.13
| Facility | | $144.54 | $213.80 | $331.13 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $141.25 / $204.17 / $8,709.64
| Facility | | $141.25 | $204.17 | $8,709.64 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,890.45 / $7,244.36 / $14,125.38
| Facility | | $3,890.45 | $7,244.36 | $14,125.38 |