- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $616.60 / $3,388.44 / $9,120.11
| Facility | | $616.60 | $3,388.44 | $9,120.11 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $363.08 / $489.78 / $933.25
| Professional | | $363.08 | $489.78 | $933.25 |
- 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
- $354.81 / $501.19 / $977.24
| Professional | | $354.81 | $501.19 | $977.24 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $436.52 / $1,202.26 / $3,388.44
| Facility | | $436.52 | $1,202.26 | $3,388.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $354.81 / $575.44 / $1,318.26
| Professional | | $354.81 | $575.44 | $1,318.26 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $912.01 / $2,884.03 / $6,456.54
| Facility | | $912.01 | $2,884.03 | $6,456.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $331.13 / $457.09 / $870.96
| Professional | | $331.13 | $457.09 | $870.96 |