- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,949.84 / $6,760.83 / $10,964.78
| Facility | | $1,949.84 | $6,760.83 | $10,964.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,096.48 / $1,548.82 / $1,905.46
| Professional | | $1,096.48 | $1,548.82 | $1,905.46 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,511.89 / $5,623.41 / $9,332.54
| Facility | | $2,511.89 | $5,623.41 | $9,332.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $812.83 / $812.83 / $1,949.84
| Professional | | $812.83 | $812.83 | $1,949.84 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,047.13 / $1,258.93 / $5,888.44
| Facility | | $1,047.13 | $1,258.93 | $5,888.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,344.23 / $2,398.83 / $2,818.38
| Professional | | $2,344.23 | $2,398.83 | $2,818.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,691.53 / $2,691.53 / $2,754.23
| Professional | | $2,691.53 | $2,691.53 | $2,754.23 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,348.96 / $1,949.84 / $1,949.84
| Professional | | $1,348.96 | $1,949.84 | $1,949.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $812.83 / $812.83 / $1,174.90
| Professional | | $812.83 | $812.83 | $1,174.90 |