- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,318.26 / $4,073.80 / $7,762.47
| Facility | | $1,318.26 | $4,073.80 | $7,762.47 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,122.02 / $1,288.25 / $1,698.24
| Professional | | $1,122.02 | $1,288.25 | $1,698.24 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $660.69 / $1,778.28 / $7,943.28
| Professional | | $660.69 | $1,778.28 | $7,943.28 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $758.58 / $1,288.25 / $3,467.37
| Professional | | $758.58 | $1,288.25 | $3,467.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,202.26 / $2,570.40 / $2,884.03
| Professional | | $1,202.26 | $2,570.40 | $2,884.03 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,311.31 / $13,489.63 / $26,915.35
| Facility | | $3,311.31 | $13,489.63 | $26,915.35 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $524.81 / $1,548.82 / $3,467.37
| Professional | | $524.81 | $1,548.82 | $3,467.37 |