- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $831.76 / $5,495.41 / $9,549.93
| Facility | | $831.76 | $5,495.41 | $9,549.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $229.09 / $457.09 / $1,202.26
| Professional | | $229.09 | $457.09 | $1,202.26 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,137.96 / $3,162.28 / $10,471.29
| Facility | | $2,137.96 | $3,162.28 | $10,471.29 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $288.40 / $426.58 / $575.44
| Professional | | $288.40 | $426.58 | $575.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $346.74 / $602.56 / $1,071.52
| Professional | | $346.74 | $602.56 | $1,071.52 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $501.19 / $524.81 / $758.58
| Professional | | $501.19 | $524.81 | $758.58 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,288.25 / $3,890.45 / $6,760.83
| Facility | | $1,288.25 | $3,890.45 | $6,760.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $281.84 / $426.58 / $724.44
| Professional | | $281.84 | $426.58 | $724.44 |