- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $851.14 / $5,623.41 / $16,218.10
| Facility | | $851.14 | $5,623.41 | $16,218.10 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $446.68 / $3,388.44 / $10,232.93
| Professional | | $446.68 | $3,388.44 | $10,232.93 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,365.16 / $11,481.54 / $26,302.68
| Facility | | $4,365.16 | $11,481.54 | $26,302.68 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $436.52 / $4,073.80 / $9,549.93
| Professional | | $436.52 | $4,073.80 | $9,549.93 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $724.44 / $15,135.61 / $34,673.69
| Facility | | $724.44 | $15,135.61 | $34,673.69 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $501.19 / $1,778.28 / $11,748.98
| Professional | | $501.19 | $1,778.28 | $11,748.98 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,630.78 / $10,964.78 / $27,542.29
| Facility | | $3,630.78 | $10,964.78 | $27,542.29 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $457.09 / $3,715.35 / $9,120.11
| Professional | | $457.09 | $3,715.35 | $9,120.11 |