- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,737.80 / $4,786.30 / $11,748.98
| Facility | | $1,737.80 | $4,786.30 | $11,748.98 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,513.56 / $1,905.46 / $3,715.35
| Professional | | $1,513.56 | $1,905.46 | $3,715.35 |
- 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
- $1,445.44 / $2,398.83 / $4,786.30
| Professional | | $1,445.44 | $2,398.83 | $4,786.30 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $398.11 / $4,073.80 / $10,471.29
| Facility | | $398.11 | $4,073.80 | $10,471.29 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,698.24 / $2,884.03 / $5,248.07
| Professional | | $1,698.24 | $2,884.03 | $5,248.07 |
- 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
- $1,513.56 / $2,454.71 / $4,073.80
| Professional | | $1,513.56 | $2,454.71 | $4,073.80 |