- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,288.25 / $3,890.45 / $8,511.38
| Facility | | $1,288.25 | $3,890.45 | $8,511.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $323.59 / $1,348.96 / $2,398.83
| Professional | | $323.59 | $1,348.96 | $2,398.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $346.74 / $794.33 / $2,344.23
| Professional | | $346.74 | $794.33 | $2,344.23 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $380.19 / $1,819.70 / $2,884.03
| Professional | | $380.19 | $1,819.70 | $2,884.03 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $371.54 / $2,238.72 / $7,943.28
| Facility | | $371.54 | $2,238.72 | $7,943.28 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,548.82 / $2,454.71 / $14,125.38
| Professional | | $1,548.82 | $2,454.71 | $14,125.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,621.81 / $5,754.40 / $10,471.29
| Facility | | $1,621.81 | $5,754.40 | $10,471.29 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $331.13 / $1,318.26 / $2,691.53
| Professional | | $331.13 | $1,318.26 | $2,691.53 |