- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,137.96 / $4,466.84 / $10,232.93
| Facility | | $2,137.96 | $4,466.84 | $10,232.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $645.65 / $4,466.84 / $10,232.93
| Professional | | $645.65 | $4,466.84 | $10,232.93 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,467.37 / $9,120.11 / $16,595.87
| Facility | | $3,467.37 | $9,120.11 | $16,595.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $158.49 / $1,548.82 / $3,090.30
| Professional | | $158.49 | $1,548.82 | $3,090.30 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,884.03 / $2,884.03 / $2,884.03
| Professional | | $2,884.03 | $2,884.03 | $2,884.03 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $776.25 / $1,905.46 / $6,606.93
| Facility | | $776.25 | $1,905.46 | $6,606.93 |