- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $724.44 / $1,445.44 / $7,943.28
| Facility | | $724.44 | $1,445.44 | $7,943.28 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $457.09 / $4,265.80 / $13,182.57
| Professional | | $457.09 | $4,265.80 | $13,182.57 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $257.04 / $478.63 / $501.19
| Professional | | $257.04 | $478.63 | $501.19 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $15,135.61 / $17,782.79 / $23,988.33
| Facility | | $15,135.61 | $17,782.79 | $23,988.33 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $363.08 / $3,235.94 / $5,128.61
| Professional | | $363.08 | $3,235.94 | $5,128.61 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $389.05 / $776.25 / $7,244.36
| Professional | | $389.05 | $776.25 | $7,244.36 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,511.89 / $6,456.54 / $12,022.64
| Facility | | $2,511.89 | $6,456.54 | $12,022.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $363.08 / $3,311.31 / $6,025.60
| Professional | | $363.08 | $3,311.31 | $6,025.60 |