- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $933.25 / $4,073.80 / $7,762.47
| Facility | | $933.25 | $4,073.80 | $7,762.47 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $741.31 / $870.96 / $2,344.23
| Professional | | $741.31 | $870.96 | $2,344.23 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $870.96 / $2,398.83 / $10,715.19
| Professional | | $870.96 | $2,398.83 | $10,715.19 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $870.96 / $1,122.02 / $2,511.89
| Professional | | $870.96 | $1,122.02 | $2,511.89 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $912.01 / $1,659.59 / $2,041.74
| Professional | | $912.01 | $1,659.59 | $2,041.74 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,311.31 / $16,218.10 / $35,481.34
| Facility | | $3,311.31 | $16,218.10 | $35,481.34 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $676.08 / $1,096.48 / $2,398.83
| Professional | | $676.08 | $1,096.48 | $2,398.83 |