- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,202.26 / $4,073.80 / $7,762.47
| Facility | | $1,202.26 | $4,073.80 | $7,762.47 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $758.58 / $1,023.29 / $2,137.96
| Professional | | $758.58 | $1,023.29 | $2,137.96 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $870.96 / $2,818.38 / $10,715.19
| Professional | | $870.96 | $2,818.38 | $10,715.19 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $741.31 / $891.25 / $2,630.27
| Professional | | $741.31 | $891.25 | $2,630.27 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $891.25 / $1,023.29 / $2,137.96
| Professional | | $891.25 | $1,023.29 | $2,137.96 |
- 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
- $602.56 / $870.96 / $2,398.83
| Professional | | $602.56 | $870.96 | $2,398.83 |