- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $851.14 / $3,890.45 / $10,471.29
| Facility | | $851.14 | $3,890.45 | $10,471.29 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $575.44 / $758.58 / $1,698.24
| Professional | | $575.44 | $758.58 | $1,698.24 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,041.74 / $6,025.60 / $12,302.69
| Facility | | $2,041.74 | $6,025.60 | $12,302.69 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $588.84 / $851.14 / $1,621.81
| Professional | | $588.84 | $851.14 | $1,621.81 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $831.76 / $1,862.09 / $6,165.95
| Facility | | $831.76 | $1,862.09 | $6,165.95 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $616.60 / $977.24 / $2,137.96
| Professional | | $616.60 | $977.24 | $2,137.96 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,445.44 / $4,168.69 / $9,549.93
| Facility | | $1,445.44 | $4,168.69 | $9,549.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $562.34 / $831.76 / $1,548.82
| Professional | | $562.34 | $831.76 | $1,548.82 |