- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $891.25 / $5,754.40 / $15,848.93
| Facility | | $891.25 | $5,754.40 | $15,848.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $478.63 / $1,659.59 / $12,882.50
| Professional | | $478.63 | $1,659.59 | $12,882.50 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,466.84 / $11,748.98 / $26,302.68
| Facility | | $4,466.84 | $11,748.98 | $26,302.68 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $489.78 / $6,456.54 / $15,848.93
| Professional | | $489.78 | $6,456.54 | $15,848.93 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $794.33 / $22,387.21 / $52,480.75
| Facility | | $794.33 | $22,387.21 | $52,480.75 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $562.34 / $1,862.09 / $18,197.01
| Professional | | $562.34 | $1,862.09 | $18,197.01 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,630.78 / $11,481.54 / $28,840.32
| Facility | | $3,630.78 | $11,481.54 | $28,840.32 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $501.19 / $5,888.44 / $14,454.40
| Professional | | $501.19 | $5,888.44 | $14,454.40 |