- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $758.58 / $2,691.53 / $4,365.16
| Facility | | $758.58 | $2,691.53 | $4,365.16 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $549.54 / $691.83 / $1,023.29
| Professional | | $549.54 | $691.83 | $1,023.29 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,073.80 / $6,918.31 / $9,772.37
| Facility | | $4,073.80 | $6,918.31 | $9,772.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $676.08 / $794.33 / $977.24
| Professional | | $676.08 | $794.33 | $977.24 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $39.81 / $39.81 / $39.81
| Facility | | $39.81 | $39.81 | $39.81 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $478.63 / $741.31 / $1,096.48
| Professional | | $478.63 | $741.31 | $1,096.48 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,023.29 / $3,548.13 / $9,549.93
| Facility | | $1,023.29 | $3,548.13 | $9,549.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $549.54 / $707.95 / $1,122.02
| Professional | | $549.54 | $707.95 | $1,122.02 |