- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $250.94 / $6,732.54 / $10,521.04
| Facility | | $250.94 | $6,732.54 | $10,521.04 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $250.95 / $467.10 / $2,557.71
| Professional | | $250.95 | $467.10 | $2,557.71 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $277.91 / $472.56 / $2,915.49
| Professional | | $277.91 | $472.56 | $2,915.49 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $333.81 / $2,293.84 / $4,959.93
| Professional | | $333.81 | $2,293.84 | $4,959.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $303.38 / $699.75 / $3,786.09
| Professional | | $303.38 | $699.75 | $3,786.09 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $290.73 / $6,773.20 / $17,971.62
| Facility | | $290.73 | $6,773.20 | $17,971.62 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $250.94 / $449.80 / $2,589.37
| Professional | | $250.94 | $449.80 | $2,589.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,683.86 / $2,367.64 / $4,284.31
| Professional | | $1,683.86 | $2,367.64 | $4,284.31 |