- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $616.60 / $4,265.80 / $10,964.78
| Facility | | $616.60 | $4,265.80 | $10,964.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $218.78 / $758.58 / $3,981.07
| Professional | | $218.78 | $758.58 | $3,981.07 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,548.13 / $9,332.54 / $17,782.79
| Facility | | $3,548.13 | $9,332.54 | $17,782.79 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $239.88 / $1,995.26 / $5,370.32
| Professional | | $239.88 | $1,995.26 | $5,370.32 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $323.59 / $6,309.57 / $18,197.01
| Facility | | $323.59 | $6,309.57 | $18,197.01 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $269.15 / $977.24 / $5,623.41
| Professional | | $269.15 | $977.24 | $5,623.41 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,951.21 / $8,511.38 / $18,197.01
| Facility | | $2,951.21 | $8,511.38 | $18,197.01 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $234.42 / $1,862.09 / $4,786.30
| Professional | | $234.42 | $1,862.09 | $4,786.30 |