- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $711.02 / $1,562.34 / $4,443.88
| Facility | | $711.02 | $1,562.34 | $4,443.88 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $444.39 / $444.39 / $514.22
| Professional | | $444.39 | $444.39 | $514.22 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,044.31 / $1,160.49 / $2,475.88
| Facility | | $1,044.31 | $1,160.49 | $2,475.88 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $257.13 / $412.64 / $412.65
| Professional | | $257.13 | $412.64 | $412.65 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,146.33 / $2,321.05 / $2,784.97
| Facility | | $1,146.33 | $2,321.05 | $2,784.97 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $634.84 / $921.41 / $2,258.69
| Professional | | $634.84 | $921.41 | $2,258.69 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $266.63 / $380.90 / $634.84
| Professional | | $266.63 | $380.90 | $634.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,500.00 / $2,750.00 / $3,500.00
| Professional | | $2,500.00 | $2,750.00 | $3,500.00 |