- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,698.24 / $5,495.41 / $7,762.47
| Facility | | $1,698.24 | $5,495.41 | $7,762.47 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,148.15 / $1,479.11 / $3,162.28
| Professional | | $1,148.15 | $1,479.11 | $3,162.28 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,230.27 / $4,365.16 / $10,715.19
| Professional | | $1,230.27 | $4,365.16 | $10,715.19 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,096.48 / $1,445.44 / $3,715.35
| Professional | | $1,096.48 | $1,445.44 | $3,715.35 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,230.27 / $1,412.54 / $3,019.95
| Professional | | $1,230.27 | $1,412.54 | $3,019.95 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,311.31 / $16,218.10 / $26,915.35
| Facility | | $3,311.31 | $16,218.10 | $26,915.35 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $912.01 / $1,288.25 / $3,467.37
| Professional | | $912.01 | $1,288.25 | $3,467.37 |