- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,041.74 / $2,754.23 / $6,606.93
| Facility | | $2,041.74 | $2,754.23 | $6,606.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,174.90 / $1,445.44 / $1,698.24
| Professional | | $1,174.90 | $1,445.44 | $1,698.24 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,778.28 / $1,778.28 / $5,370.32
| Facility | | $1,778.28 | $1,778.28 | $5,370.32 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $28.18 / $33.11 / $69.18
| Professional | | $28.18 | $33.11 | $69.18 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,698.24 / $25,703.96 / $38,904.51
| Facility | | $1,698.24 | $25,703.96 | $38,904.51 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,148.15 / $1,148.15 / $6,918.31
| Facility | | $1,148.15 | $1,148.15 | $6,918.31 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,041.74 / $2,187.76 / $5,370.32
| Professional | | $2,041.74 | $2,187.76 | $5,370.32 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,778.28 / $1,778.28 / $1,778.28
| Facility | | $1,778.28 | $1,778.28 | $1,778.28 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $741.31 / $1,071.52 / $1,778.28
| Professional | | $741.31 | $1,071.52 | $1,778.28 |