- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,570.88 / $9,772.37 / $10,232.93
| Facility | | $4,570.88 | $9,772.37 | $10,232.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $389.05 / $1,122.02 / $2,454.71
| Professional | | $389.05 | $1,122.02 | $2,454.71 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $302.00 / $741.31 / $2,398.83
| Professional | | $302.00 | $741.31 | $2,398.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $436.52 / $630.96 / $2,754.23
| Professional | | $436.52 | $630.96 | $2,754.23 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $371.54 / $1,258.93 / $2,691.53
| Professional | | $371.54 | $1,258.93 | $2,691.53 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,570.88 / $9,772.37 / $10,715.19
| Facility | | $4,570.88 | $9,772.37 | $10,715.19 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $371.54 / $1,148.15 / $3,090.30
| Professional | | $371.54 | $1,148.15 | $3,090.30 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $457.09 / $1,548.82 / $2,691.53
| Professional | | $457.09 | $1,548.82 | $2,691.53 |