- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $776.25 / $3,715.35 / $9,549.93
| Facility | | $776.25 | $3,715.35 | $9,549.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $363.08 / $446.68 / $1,000.00
| Professional | | $363.08 | $446.68 | $1,000.00 |
- 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
- $346.74 / $537.03 / $1,047.13
| Professional | | $346.74 | $537.03 | $1,047.13 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $676.08 / $1,445.44 / $3,388.44
| Facility | | $676.08 | $1,445.44 | $3,388.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $380.19 / $616.60 / $1,318.26
| Professional | | $380.19 | $616.60 | $1,318.26 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,584.89 / $4,365.16 / $10,232.93
| Facility | | $1,584.89 | $4,365.16 | $10,232.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $346.74 / $501.19 / $933.25
| Professional | | $346.74 | $501.19 | $933.25 |