- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,290.87 / $12,022.64 / $16,218.10
| Facility | | $2,290.87 | $12,022.64 | $16,218.10 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,801.89 / $7,943.28 / $7,943.28
| Professional | | $3,801.89 | $7,943.28 | $7,943.28 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $64.57 / $64.57 / $64.57
| Facility | | $64.57 | $64.57 | $64.57 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $354.81 / $2,951.21 / $19,498.45
| Facility | | $354.81 | $2,951.21 | $19,498.45 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,290.87 / $12,022.64 / $16,218.10
| Facility | | $2,290.87 | $12,022.64 | $16,218.10 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,801.89 / $7,943.28 / $7,943.28
| Professional | | $3,801.89 | $7,943.28 | $7,943.28 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $0.60 / $0.60 / $0.60
| Professional | | $0.60 | $0.60 | $0.60 |