- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $676.62 / $3,772.57 / $8,373.50
| Facility | | $676.62 | $3,772.57 | $8,373.50 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $275.14 / $406.27 / $673.77
| Professional | | $275.14 | $406.27 | $673.77 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,452.00 / $7,264.00 / $10,705.00
| Facility | | $4,452.00 | $7,264.00 | $10,705.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $463.35 / $1,715.24 / $2,308.19
| Professional | | $463.35 | $1,715.24 | $2,308.19 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,652.37 / $2,652.37 / $3,177.28
| Facility | | $2,652.37 | $2,652.37 | $3,177.28 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $397.50 / $907.24 / $907.24
| Professional | | $397.50 | $907.24 | $907.24 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,206.00 / $6,578.00 / $12,241.00
| Facility | | $3,206.00 | $6,578.00 | $12,241.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $578.88 / $867.57 / $1,420.43
| Professional | | $578.88 | $867.57 | $1,420.43 |