- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,479.11 / $5,128.61 / $7,762.47
| Facility | | $1,479.11 | $5,128.61 | $7,762.47 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $891.25 / $1,445.44 / $3,311.31
| Professional | | $891.25 | $1,445.44 | $3,311.31 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,258.93 / $8,128.31 / $16,982.44
| Professional | | $1,258.93 | $8,128.31 | $16,982.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,122.02 / $1,513.56 / $3,235.94
| Professional | | $1,122.02 | $1,513.56 | $3,235.94 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,148.15 / $1,202.26 / $2,818.38
| Professional | | $1,148.15 | $1,202.26 | $2,818.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,073.80 / $16,218.10 / $33,884.42
| Facility | | $4,073.80 | $16,218.10 | $33,884.42 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,023.29 / $1,445.44 / $3,162.28
| Professional | | $1,023.29 | $1,445.44 | $3,162.28 |