- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,137.96 / $5,248.07 / $10,232.93
| Facility | | $2,137.96 | $5,248.07 | $10,232.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,089.30 / $2,754.23 / $4,365.16
| Professional | | $2,089.30 | $2,754.23 | $4,365.16 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $363.08 / $380.19 / $457.09
| Professional | | $363.08 | $380.19 | $457.09 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $281.84 / $2,511.89 / $3,467.37
| Facility | | $281.84 | $2,511.89 | $3,467.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,511.89 / $2,511.89 / $11,481.54
| Professional | | $2,511.89 | $2,511.89 | $11,481.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,995.26 / $4,897.79 / $4,897.79
| Facility | | $1,995.26 | $4,897.79 | $4,897.79 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,511.89 / $2,511.89 / $2,691.53
| Professional | | $2,511.89 | $2,511.89 | $2,691.53 |