- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,691.53 / $5,495.41 / $14,454.40
| Facility | | $2,691.53 | $5,495.41 | $14,454.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,905.46 / $2,511.89 / $3,090.30
| Professional | | $1,905.46 | $2,511.89 | $3,090.30 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,630.27 / $4,897.79 / $15,135.61
| Facility | | $2,630.27 | $4,897.79 | $15,135.61 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,230.27 / $1,318.26 / $4,073.80
| Professional | | $1,230.27 | $1,318.26 | $4,073.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,041.74 / $5,248.07 / $13,489.63
| Facility | | $2,041.74 | $5,248.07 | $13,489.63 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,630.78 / $4,570.88 / $8,709.64
| Professional | | $3,630.78 | $4,570.88 | $8,709.64 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,905.46 / $3,162.28 / $3,801.89
| Facility | | $1,905.46 | $3,162.28 | $3,801.89 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,318.26 / $1,905.46 / $3,801.89
| Professional | | $1,318.26 | $1,905.46 | $3,801.89 |