- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,096.48 / $4,073.80 / $7,762.47
| Facility | | $1,096.48 | $4,073.80 | $7,762.47 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,071.52 / $1,122.02 / $3,019.95
| Professional | | $1,071.52 | $1,122.02 | $3,019.95 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,148.15 / $1,548.82 / $10,715.19
| Professional | | $1,148.15 | $1,548.82 | $10,715.19 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,000.00 / $1,479.11 / $2,818.38
| Professional | | $1,000.00 | $1,479.11 | $2,818.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,023.29 / $2,238.72 / $2,454.71
| Professional | | $1,023.29 | $2,238.72 | $2,454.71 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,073.80 / $16,218.10 / $42,657.95
| Facility | | $4,073.80 | $16,218.10 | $42,657.95 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $891.25 / $1,412.54 / $2,951.21
| Professional | | $891.25 | $1,412.54 | $2,951.21 |