- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,188.44 / $3,411.40 / $7,337.75
| Facility | | $2,188.44 | $3,411.40 | $7,337.75 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,802.26 / $2,111.21 / $2,317.19
| Professional | | $1,802.26 | $2,111.21 | $2,317.19 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,705.70 / $3,778.30 / $11,232.43
| Facility | | $1,705.70 | $3,778.30 | $11,232.43 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $33.20 / $39.84 / $2,574.65
| Professional | | $33.20 | $39.84 | $2,574.65 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,146.28 / $4,330.22 / $8,006.88
| Facility | | $2,146.28 | $4,330.22 | $8,006.88 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,089.58 / $3,137.97 / $3,922.46
| Professional | | $3,089.58 | $3,137.97 | $3,922.46 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,445.92 / $2,445.92 / $3,089.58
| Facility | | $2,445.92 | $2,445.92 | $3,089.58 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,081.34 / $1,544.79 / $3,089.58
| Professional | | $1,081.34 | $1,544.79 | $3,089.58 |