- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $676.08 / $4,570.88 / $8,511.38
| Facility | | $676.08 | $4,570.88 | $8,511.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $169.82 / $331.13 / $562.34
| Professional | | $169.82 | $331.13 | $562.34 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,715.35 / $4,365.16 / $10,964.78
| Facility | | $3,715.35 | $4,365.16 | $10,964.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $251.19 / $363.08 / $691.83
| Professional | | $251.19 | $363.08 | $691.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $162.18 / $416.87 / $851.14
| Professional | | $162.18 | $416.87 | $851.14 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $245.47 / $416.87 / $562.34
| Professional | | $245.47 | $416.87 | $562.34 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,905.46 / $4,570.88 / $9,332.54
| Facility | | $1,905.46 | $4,570.88 | $9,332.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $165.96 / $323.59 / $588.84
| Professional | | $165.96 | $323.59 | $588.84 |