- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,096.48 / $3,890.45 / $10,715.19
| Facility | | $1,096.48 | $3,890.45 | $10,715.19 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $851.14 / $1,096.48 / $2,691.53
| Professional | | $851.14 | $1,096.48 | $2,691.53 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,691.53 / $6,025.60 / $13,489.63
| Facility | | $2,691.53 | $6,025.60 | $13,489.63 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $891.25 / $1,202.26 / $2,344.23
| Professional | | $891.25 | $1,202.26 | $2,344.23 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,148.15 / $2,290.87 / $8,128.31
| Facility | | $1,148.15 | $2,290.87 | $8,128.31 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $933.25 / $1,380.38 / $3,019.95
| Professional | | $933.25 | $1,380.38 | $3,019.95 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,949.84 / $5,623.41 / $12,302.69
| Facility | | $1,949.84 | $5,623.41 | $12,302.69 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $831.76 / $1,174.90 / $2,187.76
| Professional | | $831.76 | $1,174.90 | $2,187.76 |