- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,096.48 / $1,445.44 / $2,398.83
| Facility | | $1,096.48 | $1,445.44 | $2,398.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,570.40 / $3,162.28 / $5,888.44
| Professional | | $2,570.40 | $3,162.28 | $5,888.44 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,709.64 / $10,471.29 / $14,125.38
| Facility | | $8,709.64 | $10,471.29 | $14,125.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,290.87 / $3,467.37 / $4,073.80
| Professional | | $2,290.87 | $3,467.37 | $4,073.80 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,398.83 / $3,388.44 / $6,918.31
| Professional | | $2,398.83 | $3,388.44 | $6,918.31 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $660.69 / $1,659.59 / $5,248.07
| Facility | | $660.69 | $1,659.59 | $5,248.07 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,187.76 / $3,090.30 / $4,897.79
| Professional | | $2,187.76 | $3,090.30 | $4,897.79 |