- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $660.69 / $4,073.80 / $7,762.47
| Facility | | $660.69 | $4,073.80 | $7,762.47 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $489.78 / $588.84 / $1,445.44
| Professional | | $489.78 | $588.84 | $1,445.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $562.34 / $2,238.72 / $6,025.60
| Professional | | $562.34 | $2,238.72 | $6,025.60 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $524.81 / $660.69 / $1,659.59
| Professional | | $524.81 | $660.69 | $1,659.59 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $630.96 / $1,230.27 / $1,479.11
| Professional | | $630.96 | $1,230.27 | $1,479.11 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,344.23 / $7,943.28 / $26,302.68
| Facility | | $2,344.23 | $7,943.28 | $26,302.68 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $457.09 / $602.56 / $1,318.26
| Professional | | $457.09 | $602.56 | $1,318.26 |