- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,122.02 / $3,388.44 / $11,481.54
| Facility | | $1,122.02 | $3,388.44 | $11,481.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $660.69 / $1,000.00 / $2,630.27
| Professional | | $660.69 | $1,000.00 | $2,630.27 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $933.25 / $1,862.09 / $17,378.01
| Facility | | $933.25 | $1,862.09 | $17,378.01 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,412.54 / $1,584.89 / $1,949.84
| Professional | | $1,412.54 | $1,584.89 | $1,949.84 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,495.41 / $9,549.93 / $19,498.45
| Facility | | $5,495.41 | $9,549.93 | $19,498.45 |