- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $933.25 / $4,466.84 / $10,964.78
| Facility | | $933.25 | $4,466.84 | $10,964.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $426.58 / $537.03 / $1,202.26
| Professional | | $426.58 | $537.03 | $1,202.26 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,630.27 / $6,456.54 / $12,589.25
| Facility | | $2,630.27 | $6,456.54 | $12,589.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $426.58 / $616.60 / $1,174.90
| Professional | | $426.58 | $616.60 | $1,174.90 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $512.86 / $1,380.38 / $3,801.89
| Facility | | $512.86 | $1,380.38 | $3,801.89 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $467.74 / $707.95 / $1,621.81
| Professional | | $467.74 | $707.95 | $1,621.81 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,348.96 / $4,073.80 / $9,549.93
| Facility | | $1,348.96 | $4,073.80 | $9,549.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $398.11 / $575.44 / $1,096.48
| Professional | | $398.11 | $575.44 | $1,096.48 |