- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,457.41 / $1,647.84 / $5,304.96
| Facility | | $1,457.41 | $1,647.84 | $5,304.96 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,457.41 / $1,515.70 / $1,651.73
| Professional | | $1,457.41 | $1,515.70 | $1,651.73 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,010.47 / $2,565.04 / $3,828.12
| Professional | | $1,010.47 | $2,565.04 | $3,828.12 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,282.04 / $3,856.42 / $6,938.99
| Facility | | $1,282.04 | $3,856.42 | $6,938.99 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,943.21 / $1,943.21 / $9,366.27
| Professional | | $1,943.21 | $1,943.21 | $9,366.27 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,381.19 / $9,230.25 / $9,230.25
| Facility | | $3,381.19 | $9,230.25 | $9,230.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $9,677.19 / $9,677.19 / $14,574.08
| Professional | | $9,677.19 | $9,677.19 | $14,574.08 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $816.15 / $1,165.93 / $1,943.21
| Professional | | $816.15 | $1,165.93 | $1,943.21 |