- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,700.96 / $2,126.19 / $5,102.88
| Facility | | $1,700.96 | $2,126.19 | $5,102.88 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,594.65 / $1,594.65 / $1,700.96
| Professional | | $1,594.65 | $1,594.65 | $1,700.96 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,382.03 / $1,382.03 / $1,865.74
| Facility | | $1,382.03 | $1,382.03 | $1,865.74 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,589.91 / $2,589.91 / $3,103.00
| Professional | | $2,589.91 | $2,589.91 | $3,103.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,594.65 / $1,871.06 / $3,572.02
| Facility | | $1,594.65 | $1,871.06 | $3,572.02 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $893.00 / $893.00 / $2,657.75
| Professional | | $893.00 | $893.00 | $2,657.75 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,551.44 / $2,657.75 / $3,013.89
| Facility | | $2,551.44 | $2,657.75 | $3,013.89 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $893.00 / $893.00 / $2,126.19
| Professional | | $893.00 | $893.00 | $2,126.19 |