- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,445.44 / $4,570.88 / $11,220.18
| Facility | | $1,445.44 | $4,570.88 | $11,220.18 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,230.27 / $1,548.82 / $3,311.31
| Professional | | $1,230.27 | $1,548.82 | $3,311.31 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,073.80 / $11,481.54 / $22,387.21
| Facility | | $4,073.80 | $11,481.54 | $22,387.21 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,258.93 / $1,862.09 / $3,388.44
| Professional | | $1,258.93 | $1,862.09 | $3,388.44 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $323.59 / $3,890.45 / $11,220.18
| Facility | | $323.59 | $3,890.45 | $11,220.18 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,318.26 / $2,089.30 / $4,265.80
| Professional | | $1,318.26 | $2,089.30 | $4,265.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $851.14 / $3,162.28 / $10,232.93
| Facility | | $851.14 | $3,162.28 | $10,232.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,202.26 / $1,698.24 / $3,162.28
| Professional | | $1,202.26 | $1,698.24 | $3,162.28 |