- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $512.86 / $2,137.96 / $6,456.54
| Facility | | $512.86 | $2,137.96 | $6,456.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $309.03 / $478.63 / $2,089.30
| Professional | | $309.03 | $478.63 | $2,089.30 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $363.08 / $2,398.83 / $6,456.54
| Professional | | $363.08 | $2,398.83 | $6,456.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $346.74 / $602.56 / $1,174.90
| Professional | | $346.74 | $602.56 | $1,174.90 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $524.81 / $776.25 / $1,122.02
| Professional | | $524.81 | $776.25 | $1,122.02 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,344.23 / $13,489.63 / $26,302.68
| Facility | | $2,344.23 | $13,489.63 | $26,302.68 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $309.03 / $562.34 / $1,122.02
| Professional | | $309.03 | $562.34 | $1,122.02 |