- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $537.03 / $3,162.28 / $8,912.51
| Facility | | $537.03 | $3,162.28 | $8,912.51 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $154.88 / $2,344.23 / $5,011.87
| Professional | | $154.88 | $2,344.23 | $5,011.87 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,019.95 / $6,456.54 / $14,125.38
| Facility | | $3,019.95 | $6,456.54 | $14,125.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $169.82 / $2,398.83 / $5,370.32
| Professional | | $169.82 | $2,398.83 | $5,370.32 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $194.98 / $6,918.31 / $20,417.38
| Facility | | $194.98 | $6,918.31 | $20,417.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $204.17 / $2,290.87 / $7,244.36
| Professional | | $204.17 | $2,290.87 | $7,244.36 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,454.71 / $7,244.36 / $16,218.10
| Facility | | $2,454.71 | $7,244.36 | $16,218.10 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $173.78 / $2,041.74 / $5,888.44
| Professional | | $173.78 | $2,041.74 | $5,888.44 |