- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $354.81 / $6,025.60 / $7,943.28
| Facility | | $354.81 | $6,025.60 | $7,943.28 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $331.13 / $380.19 / $831.76
| Professional | | $331.13 | $380.19 | $831.76 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $416.87 / $1,071.52 / $3,715.35
| Professional | | $416.87 | $1,071.52 | $3,715.35 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $151.36 / $151.36 / $151.36
| Professional | | $151.36 | $151.36 | $151.36 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $707.95 / $25,703.96 / $67,608.30
| Facility | | $707.95 | $25,703.96 | $67,608.30 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $954.99 / $1,513.56 / $3,548.13
| Professional | | $954.99 | $1,513.56 | $3,548.13 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $416.87 / $1,174.90 / $3,715.35
| Professional | | $416.87 | $1,174.90 | $3,715.35 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $16,218.10 / $25,703.96 / $58,884.37
| Facility | | $16,218.10 | $25,703.96 | $58,884.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,000.00 / $1,548.82 / $3,090.30
| Professional | | $1,000.00 | $1,548.82 | $3,090.30 |