- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $776.25 / $4,570.88 / $11,220.18
| Facility | | $776.25 | $4,570.88 | $11,220.18 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $501.19 / $602.56 / $1,122.02
| Professional | | $501.19 | $602.56 | $1,122.02 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,884.03 / $7,413.10 / $14,791.08
| Facility | | $2,884.03 | $7,413.10 | $14,791.08 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $457.09 / $602.56 / $1,148.15
| Professional | | $457.09 | $602.56 | $1,148.15 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $426.58 / $954.99 / $2,630.27
| Facility | | $426.58 | $954.99 | $2,630.27 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $457.09 / $707.95 / $1,584.89
| Professional | | $457.09 | $707.95 | $1,584.89 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $524.81 / $2,818.38 / $9,772.37
| Facility | | $524.81 | $2,818.38 | $9,772.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $436.52 / $602.56 / $1,122.02
| Professional | | $436.52 | $602.56 | $1,122.02 |