- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $630.96 / $4,570.88 / $11,481.54
| Facility | | $630.96 | $4,570.88 | $11,481.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $331.13 / $426.58 / $954.99
| Professional | | $331.13 | $426.58 | $954.99 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,548.13 / $8,912.51 / $16,982.44
| Facility | | $3,548.13 | $8,912.51 | $16,982.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $331.13 / $602.56 / $1,122.02
| Professional | | $331.13 | $602.56 | $1,122.02 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $338.84 / $933.25 / $2,570.40
| Facility | | $338.84 | $933.25 | $2,570.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $380.19 / $660.69 / $1,174.90
| Professional | | $380.19 | $660.69 | $1,174.90 |
- 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
- $338.84 / $575.44 / $954.99
| Professional | | $338.84 | $575.44 | $954.99 |