- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,659.59 / $4,570.88 / $11,220.18
| Facility | | $1,659.59 | $4,570.88 | $11,220.18 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,548.82 / $1,949.84 / $4,073.80
| Professional | | $1,548.82 | $1,949.84 | $4,073.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,570.88 / $13,182.57 / $28,840.32
| Facility | | $4,570.88 | $13,182.57 | $28,840.32 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,380.38 / $2,089.30 / $4,168.69
| Professional | | $1,380.38 | $2,089.30 | $4,168.69 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $398.11 / $3,981.07 / $11,481.54
| Facility | | $398.11 | $3,981.07 | $11,481.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,479.11 / $2,630.27 / $5,495.41
| Professional | | $1,479.11 | $2,630.27 | $5,495.41 |
- 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
- $1,412.54 / $2,089.30 / $3,890.45
| Professional | | $1,412.54 | $2,089.30 | $3,890.45 |