- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $870.96 / $4,570.88 / $11,481.54
| Facility | | $870.96 | $4,570.88 | $11,481.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $602.56 / $758.58 / $1,412.54
| Professional | | $602.56 | $758.58 | $1,412.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,884.03 / $7,413.10 / $15,135.61
| Facility | | $2,884.03 | $7,413.10 | $15,135.61 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $549.54 / $831.76 / $1,584.89
| Professional | | $549.54 | $831.76 | $1,584.89 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $630.96 / $1,584.89 / $4,570.88
| Facility | | $630.96 | $1,584.89 | $4,570.88 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $630.96 / $1,000.00 / $1,905.46
| Professional | | $630.96 | $1,000.00 | $1,905.46 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,995.26 / $5,623.41 / $12,302.69
| Facility | | $1,995.26 | $5,623.41 | $12,302.69 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $575.44 / $831.76 / $1,513.56
| Professional | | $575.44 | $831.76 | $1,513.56 |