- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,949.84 / $5,011.87 / $11,481.54
| Facility | | $1,949.84 | $5,011.87 | $11,481.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,187.76 / $2,570.40 / $5,370.32
| Professional | | $2,187.76 | $2,570.40 | $5,370.32 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,548.13 / $9,332.54 / $17,782.79
| Facility | | $3,548.13 | $9,332.54 | $17,782.79 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,187.76 / $3,235.94 / $5,888.44
| Professional | | $2,187.76 | $3,235.94 | $5,888.44 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $323.59 / $6,309.57 / $17,378.01
| Facility | | $323.59 | $6,309.57 | $17,378.01 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,344.23 / $3,630.78 / $7,585.78
| Professional | | $2,344.23 | $3,630.78 | $7,585.78 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,344.23 / $7,244.36 / $16,595.87
| Facility | | $2,344.23 | $7,244.36 | $16,595.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,041.74 / $2,884.03 / $5,370.32
| Professional | | $2,041.74 | $2,884.03 | $5,370.32 |