- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,202.26 / $2,630.27 / $8,912.51
| Facility | | $1,202.26 | $2,630.27 | $8,912.51 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $363.08 / $575.44 / $912.01
| Professional | | $363.08 | $575.44 | $912.01 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $602.56 / $22,908.68 / $52,480.75
| Facility | | $602.56 | $22,908.68 | $52,480.75 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $549.54 / $912.01 / $3,715.35
| Professional | | $549.54 | $912.01 | $3,715.35 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9,772.37 / $26,302.68 / $46,773.51
| Facility | | $9,772.37 | $26,302.68 | $46,773.51 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $676.08 / $912.01 / $1,288.25
| Professional | | $676.08 | $912.01 | $1,288.25 |