- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $724.44 / $4,073.80 / $7,762.47
| Facility | | $724.44 | $4,073.80 | $7,762.47 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $630.96 / $724.44 / $2,238.72
| Professional | | $630.96 | $724.44 | $2,238.72 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $758.58 / $1,659.59 / $7,943.28
| Professional | | $758.58 | $1,659.59 | $7,943.28 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $691.83 / $1,096.48 / $1,905.46
| Professional | | $691.83 | $1,096.48 | $1,905.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $676.08 / $1,412.54 / $1,584.89
| Professional | | $676.08 | $1,412.54 | $1,584.89 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,344.23 / $16,218.10 / $35,481.34
| Facility | | $2,344.23 | $16,218.10 | $35,481.34 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $602.56 / $912.01 / $1,949.84
| Professional | | $602.56 | $912.01 | $1,949.84 |