- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $891.25 / $3,715.35 / $9,772.37
| Facility | | $891.25 | $3,715.35 | $9,772.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $426.58 / $501.19 / $1,288.25
| Professional | | $426.58 | $501.19 | $1,288.25 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,089.30 / $5,248.07 / $11,220.18
| Facility | | $2,089.30 | $5,248.07 | $11,220.18 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $389.05 / $602.56 / $1,174.90
| Professional | | $389.05 | $602.56 | $1,174.90 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $616.60 / $1,479.11 / $3,467.37
| Facility | | $616.60 | $1,479.11 | $3,467.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $446.68 / $724.44 / $1,621.81
| Professional | | $446.68 | $724.44 | $1,621.81 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,584.89 / $4,265.80 / $9,772.37
| Facility | | $1,584.89 | $4,265.80 | $9,772.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $407.38 / $588.84 / $1,096.48
| Professional | | $407.38 | $588.84 | $1,096.48 |