- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,258.93 / $4,677.35 / $11,748.98
| Facility | | $1,258.93 | $4,677.35 | $11,748.98 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $891.25 / $1,174.90 / $3,090.30
| Professional | | $891.25 | $1,174.90 | $3,090.30 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,818.38 / $7,079.46 / $14,791.08
| Facility | | $2,818.38 | $7,079.46 | $14,791.08 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $891.25 / $1,288.25 / $2,454.71
| Professional | | $891.25 | $1,288.25 | $2,454.71 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,445.44 / $2,454.71 / $6,918.31
| Facility | | $1,445.44 | $2,454.71 | $6,918.31 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $933.25 / $1,479.11 / $3,235.94
| Professional | | $933.25 | $1,479.11 | $3,235.94 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,511.89 / $7,079.46 / $15,488.17
| Facility | | $2,511.89 | $7,079.46 | $15,488.17 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $851.14 / $1,202.26 / $2,238.72
| Professional | | $851.14 | $1,202.26 | $2,238.72 |