- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $842.44 / $9,577.00 / $14,552.94
| Facility | | $842.44 | $9,577.00 | $14,552.94 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $310.11 / $493.19 / $2,326.00
| Professional | | $310.11 | $493.19 | $2,326.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $314.52 / $537.62 / $1,387.21
| Professional | | $314.52 | $537.62 | $1,387.21 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $295.22 / $1,540.15 / $3,256.40
| Facility | | $295.22 | $1,540.15 | $3,256.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $771.16 / $1,480.04 / $2,945.14
| Professional | | $771.16 | $1,480.04 | $2,945.14 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $852.60 / $1,538.00 / $2,499.83
| Professional | | $852.60 | $1,538.00 | $2,499.83 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $331.42 / $1,540.15 / $3,256.40
| Facility | | $331.42 | $1,540.15 | $3,256.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $483.83 / $1,261.49 / $2,123.96
| Professional | | $483.83 | $1,261.49 | $2,123.96 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $573.04 / $1,100.04 / $3,034.28
| Professional | | $573.04 | $1,100.04 | $3,034.28 |