- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,318.26 / $1,698.24 / $2,344.23
| Facility | | $1,318.26 | $1,698.24 | $2,344.23 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,318.26 / $1,862.09 / $2,398.83
| Professional | | $1,318.26 | $1,862.09 | $2,398.83 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $257.04 / $323.59 / $1,513.56
| Facility | | $257.04 | $323.59 | $1,513.56 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,479.11 / $1,995.26 / $3,630.78
| Professional | | $1,479.11 | $1,995.26 | $3,630.78 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $302.00 / $891.25 / $8,912.51
| Facility | | $302.00 | $891.25 | $8,912.51 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $257.04 / $309.03 / $3,630.78
| Professional | | $257.04 | $309.03 | $3,630.78 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $138.04 / $257.04 / $2,691.53
| Facility | | $138.04 | $257.04 | $2,691.53 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $128.82 / $316.23 / $2,290.87
| Professional | | $128.82 | $316.23 | $2,290.87 |