- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $812.83 / $4,677.35 / $12,022.64
| Facility | | $812.83 | $4,677.35 | $12,022.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $501.19 / $602.56 / $1,202.26
| Professional | | $501.19 | $602.56 | $1,202.26 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,290.87 / $7,943.28 / $16,218.10
| Facility | | $2,290.87 | $7,943.28 | $16,218.10 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $489.78 / $741.31 / $1,445.44
| Professional | | $489.78 | $741.31 | $1,445.44 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $323.59 / $1,445.44 / $3,981.07
| Facility | | $323.59 | $1,445.44 | $3,981.07 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $537.03 / $870.96 / $1,659.59
| Professional | | $537.03 | $870.96 | $1,659.59 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $851.14 / $3,162.28 / $10,232.93
| Facility | | $851.14 | $3,162.28 | $10,232.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $478.63 / $741.31 / $1,288.25
| Professional | | $478.63 | $741.31 | $1,288.25 |