- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,122.02 / $4,466.84 / $10,715.19
| Facility | | $1,122.02 | $4,466.84 | $10,715.19 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $776.25 / $954.99 / $2,089.30
| Professional | | $776.25 | $954.99 | $2,089.30 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,884.03 / $7,585.78 / $16,595.87
| Facility | | $2,884.03 | $7,585.78 | $16,595.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $741.31 / $1,148.15 / $2,137.96
| Professional | | $741.31 | $1,148.15 | $2,137.96 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,445.44 / $2,630.27 / $6,025.60
| Facility | | $1,445.44 | $2,630.27 | $6,025.60 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $794.33 / $1,288.25 / $2,754.23
| Professional | | $794.33 | $1,288.25 | $2,754.23 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,995.26 / $5,754.40 / $13,489.63
| Facility | | $1,995.26 | $5,754.40 | $13,489.63 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $741.31 / $1,047.13 / $1,949.84
| Professional | | $741.31 | $1,047.13 | $1,949.84 |