- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $537.03 / $4,073.80 / $7,762.47
| Facility | | $537.03 | $4,073.80 | $7,762.47 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $426.58 / $501.19 / $1,202.26
| Professional | | $426.58 | $501.19 | $1,202.26 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $501.19 / $1,659.59 / $7,943.28
| Professional | | $501.19 | $1,659.59 | $7,943.28 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $512.86 / $588.84 / $1,412.54
| Professional | | $512.86 | $588.84 | $1,412.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $537.03 / $933.25 / $1,174.90
| Professional | | $537.03 | $933.25 | $1,174.90 |
- 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
- $354.81 / $616.60 / $1,348.96
| Professional | | $354.81 | $616.60 | $1,348.96 |