- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,095.58 / $1,670.11 / $2,004.14
| Facility | | $1,095.58 | $1,670.11 | $2,004.14 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,002.07 / $1,095.58 / $1,135.68
| Professional | | $1,002.07 | $1,095.58 | $1,135.68 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,803.72 / $7,515.51 / $36,074.44
| Facility | | $1,803.72 | $7,515.51 | $36,074.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,603.31 / $1,803.72 / $119,998.80
| Professional | | $1,603.31 | $1,803.72 | $119,998.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,085.58 / $1,603.31 / $4,007.94
| Facility | | $1,085.58 | $1,603.31 | $4,007.94 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $6,439.95 / $6,439.95 / $6,439.95
| Professional | | $6,439.95 | $6,439.95 | $6,439.95 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $801.65 / $801.65 / $801.65
| Facility | | $801.65 | $801.65 | $801.65 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $561.16 / $668.05 / $1,937.33
| Professional | | $561.16 | $668.05 | $1,937.33 |