- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $489.78 / $4,677.35 / $7,079.46
| Facility | | $489.78 | $4,677.35 | $7,079.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $251.19 / $933.25 / $5,495.41
| Professional | | $251.19 | $933.25 | $5,495.41 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $354.81 / $4,073.80 / $8,128.31
| Professional | | $354.81 | $4,073.80 | $8,128.31 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $251.19 / $1,479.11 / $5,248.07
| Professional | | $251.19 | $1,479.11 | $5,248.07 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,238.72 / $2,344.23 / $5,011.87
| Professional | | $2,238.72 | $2,344.23 | $5,011.87 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,311.31 / $16,218.10 / $27,542.29
| Facility | | $3,311.31 | $16,218.10 | $27,542.29 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $245.47 / $758.58 / $4,265.80
| Professional | | $245.47 | $758.58 | $4,265.80 |