- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $912.01 / $3,715.35 / $9,772.37
| Facility | | $912.01 | $3,715.35 | $9,772.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $524.81 / $630.96 / $1,513.56
| Professional | | $524.81 | $630.96 | $1,513.56 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,344.23 / $6,165.95 / $14,125.38
| Facility | | $2,344.23 | $6,165.95 | $14,125.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $489.78 / $741.31 / $1,412.54
| Professional | | $489.78 | $741.31 | $1,412.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $758.58 / $1,659.59 / $4,365.16
| Facility | | $758.58 | $1,659.59 | $4,365.16 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $537.03 / $851.14 / $1,862.09
| Professional | | $537.03 | $851.14 | $1,862.09 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,995.26 / $5,754.40 / $13,489.63
| Facility | | $1,995.26 | $5,754.40 | $13,489.63 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $489.78 / $691.83 / $1,288.25
| Professional | | $489.78 | $691.83 | $1,288.25 |