- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,025.41 / $1,131.03 / $1,678.47
| Facility | | $1,025.41 | $1,131.03 | $1,678.47 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,025.41 / $1,678.47 / $1,842.84
| Professional | | $1,025.41 | $1,678.47 | $1,842.84 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,195.63 / $3,839.45 / $8,545.91
| Facility | | $1,195.63 | $3,839.45 | $8,545.91 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $659.84 / $981.58 / $1,883.47
| Professional | | $659.84 | $981.58 | $1,883.47 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,103.57 / $1,298.31 / $1,521.84
| Facility | | $1,103.57 | $1,298.31 | $1,521.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $675.51 / $859.74 / $2,169.36
| Professional | | $675.51 | $859.74 | $2,169.36 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,017.86 / $1,095.95 / $1,202.36
| Professional | | $1,017.86 | $1,095.95 | $1,202.36 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $662.28 / $987.02 / $1,583.95
| Professional | | $662.28 | $987.02 | $1,583.95 |