- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $501.19 / $1,318.26 / $3,890.45
| Facility | | $501.19 | $1,318.26 | $3,890.45 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $162.18 / $2,344.23 / $4,265.80
| Professional | | $162.18 | $2,344.23 | $4,265.80 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,630.78 / $3,630.78 / $3,630.78
| Professional | | $3,630.78 | $3,630.78 | $3,630.78 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,786.30 / $8,511.38 / $12,022.64
| Facility | | $4,786.30 | $8,511.38 | $12,022.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $173.78 / $331.13 / $3,388.44
| Professional | | $173.78 | $331.13 | $3,388.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $173.78 / $501.19 / $4,466.84
| Professional | | $173.78 | $501.19 | $4,466.84 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,148.15 / $5,248.07 / $11,748.98
| Facility | | $1,148.15 | $5,248.07 | $11,748.98 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $165.96 / $2,691.53 / $5,248.07
| Professional | | $165.96 | $2,691.53 | $5,248.07 |