- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,660.34 / $4,303.49 / $11,649.20
| Facility | | $2,660.34 | $4,303.49 | $11,649.20 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,941.53 / $2,189.69 / $2,481.66
| Professional | | $1,941.53 | $2,189.69 | $2,481.66 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,776.15 / $6,745.28 / $10,685.47
| Facility | | $1,776.15 | $6,745.28 | $10,685.47 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,691.05 / $2,459.69 / $11,914.19
| Professional | | $1,691.05 | $2,459.69 | $11,914.19 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,950.26 / $4,744.35 / $8,539.83
| Facility | | $1,950.26 | $4,744.35 | $8,539.83 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,956.13 / $2,919.60 / $5,374.88
| Facility | | $1,956.13 | $2,919.60 | $5,374.88 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,226.23 / $1,226.23 / $14,539.61
| Professional | | $1,226.23 | $1,226.23 | $14,539.61 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,226.23 / $1,226.23 / $1,751.76
| Professional | | $1,226.23 | $1,226.23 | $1,751.76 |