- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $851.14 / $4,786.30 / $12,022.64
| Facility | | $851.14 | $4,786.30 | $12,022.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $537.03 / $676.08 / $1,318.26
| Professional | | $537.03 | $676.08 | $1,318.26 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,479.11 / $3,715.35 / $9,549.93
| Facility | | $1,479.11 | $3,715.35 | $9,549.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $489.78 / $707.95 / $1,348.96
| Professional | | $489.78 | $707.95 | $1,348.96 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $208.93 / $1,819.70 / $11,481.54
| Facility | | $208.93 | $1,819.70 | $11,481.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $489.78 / $794.33 / $1,819.70
| Professional | | $489.78 | $794.33 | $1,819.70 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $229.09 / $1,071.52 / $3,388.44
| Facility | | $229.09 | $1,071.52 | $3,388.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $467.74 / $645.65 / $1,202.26
| Professional | | $467.74 | $645.65 | $1,202.26 |