- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,288.25 / $5,370.32 / $13,489.63
| Facility | | $1,288.25 | $5,370.32 | $13,489.63 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $645.65 / $2,344.23 / $4,168.69
| Professional | | $645.65 | $2,344.23 | $4,168.69 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,235.94 / $6,606.93 / $14,125.38
| Facility | | $3,235.94 | $6,606.93 | $14,125.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $630.96 / $1,096.48 / $3,388.44
| Professional | | $630.96 | $1,096.48 | $3,388.44 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,148.15 / $6,309.57 / $19,498.45
| Facility | | $1,148.15 | $6,309.57 | $19,498.45 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $758.58 / $2,454.71 / $6,309.57
| Professional | | $758.58 | $2,454.71 | $6,309.57 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,548.82 / $4,570.88 / $10,964.78
| Facility | | $1,548.82 | $4,570.88 | $10,964.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $645.65 / $2,041.74 / $4,897.79
| Professional | | $645.65 | $2,041.74 | $4,897.79 |