- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $891.25 / $4,570.88 / $11,481.54
| Facility | | $891.25 | $4,570.88 | $11,481.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $575.44 / $676.08 / $1,380.38
| Professional | | $575.44 | $676.08 | $1,380.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,388.44 / $10,232.93 / $19,498.45
| Facility | | $3,388.44 | $10,232.93 | $19,498.45 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $588.84 / $891.25 / $1,584.89
| Professional | | $588.84 | $891.25 | $1,584.89 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $398.11 / $1,288.25 / $3,890.45
| Facility | | $398.11 | $1,288.25 | $3,890.45 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $630.96 / $977.24 / $1,862.09
| Professional | | $630.96 | $977.24 | $1,862.09 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,884.03 / $8,511.38 / $17,782.79
| Facility | | $2,884.03 | $8,511.38 | $17,782.79 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $549.54 / $794.33 / $1,412.54
| Professional | | $549.54 | $794.33 | $1,412.54 |