- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $758.58 / $2,454.71 / $6,606.93
| Facility | | $758.58 | $2,454.71 | $6,606.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $234.42 / $478.63 / $3,890.45
| Professional | | $234.42 | $478.63 | $3,890.45 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $251.19 / $537.03 / $3,981.07
| Professional | | $251.19 | $537.03 | $3,981.07 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $251.19 / $562.34 / $3,467.37
| Professional | | $251.19 | $562.34 | $3,467.37 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $251.19 / $1,949.84 / $3,801.89
| Facility | | $251.19 | $1,949.84 | $3,801.89 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $549.54 / $2,884.03 / $17,378.01
| Professional | | $549.54 | $2,884.03 | $17,378.01 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $524.81 / $1,949.84 / $3,467.37
| Facility | | $524.81 | $1,949.84 | $3,467.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $229.09 / $457.09 / $3,311.31
| Professional | | $229.09 | $457.09 | $3,311.31 |