- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $776.25 / $3,388.44 / $9,549.93
| Facility | | $776.25 | $3,388.44 | $9,549.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $331.13 / $912.01 / $1,995.26
| Professional | | $331.13 | $912.01 | $1,995.26 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,041.74 / $6,025.60 / $14,125.38
| Facility | | $2,041.74 | $6,025.60 | $14,125.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $338.84 / $891.25 / $2,187.76
| Professional | | $338.84 | $891.25 | $2,187.76 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $549.54 / $3,548.13 / $12,302.69
| Facility | | $549.54 | $3,548.13 | $12,302.69 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $354.81 / $977.24 / $2,818.38
| Professional | | $354.81 | $977.24 | $2,818.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,019.95 / $8,511.38 / $18,197.01
| Facility | | $3,019.95 | $8,511.38 | $18,197.01 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $323.59 / $891.25 / $2,041.74
| Professional | | $323.59 | $891.25 | $2,041.74 |