- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,698.24 / $4,073.80 / $7,762.47
| Facility | | $1,698.24 | $4,073.80 | $7,762.47 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,715.35 / $4,466.84 / $8,912.51
| Professional | | $3,715.35 | $4,466.84 | $8,912.51 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4,466.84 / $8,128.31 / $19,952.62
| Professional | | $4,466.84 | $8,128.31 | $19,952.62 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,548.13 / $5,128.61 / $13,489.63
| Professional | | $3,548.13 | $5,128.61 | $13,489.63 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4,073.80 / $4,265.80 / $8,912.51
| Professional | | $4,073.80 | $4,265.80 | $8,912.51 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,023.29 / $2,691.53 / $25,118.86
| Facility | | $1,023.29 | $2,691.53 | $25,118.86 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,311.31 / $4,677.35 / $10,715.19
| Professional | | $3,311.31 | $4,677.35 | $10,715.19 |