- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,848.56 / $8,864.35 / $16,379.66
| Facility | | $2,848.56 | $8,864.35 | $16,379.66 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,142.64 / $4,722.00 / $9,251.04
| Professional | | $3,142.64 | $4,722.00 | $9,251.04 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $898.09 / $2,908.68 / $5,596.21
| Facility | | $898.09 | $2,908.68 | $5,596.21 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $673.57 / $898.09 / $1,223.64
| Professional | | $673.57 | $898.09 | $1,223.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,326.50 / $1,326.50 / $1,326.50
| Professional | | $1,326.50 | $1,326.50 | $1,326.50 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,050.00 / $3,859.17 / $3,918.01
| Facility | | $1,050.00 | $3,859.17 | $3,918.01 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,050.00 / $1,050.00 / $1,050.00
| Professional | | $1,050.00 | $1,050.00 | $1,050.00 |