- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,548.82 / $4,570.88 / $11,481.54
| Facility | | $1,548.82 | $4,570.88 | $11,481.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,412.54 / $1,659.59 / $3,090.30
| Professional | | $1,412.54 | $1,659.59 | $3,090.30 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,890.45 / $12,022.64 / $22,908.68
| Facility | | $3,890.45 | $12,022.64 | $22,908.68 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,412.54 / $1,949.84 / $3,467.37
| Professional | | $1,412.54 | $1,949.84 | $3,467.37 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $371.54 / $2,630.27 / $7,244.36
| Facility | | $371.54 | $2,630.27 | $7,244.36 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,348.96 / $2,238.72 / $4,265.80
| Professional | | $1,348.96 | $2,238.72 | $4,265.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $537.03 / $2,818.38 / $9,772.37
| Facility | | $537.03 | $2,818.38 | $9,772.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,348.96 / $1,949.84 / $3,388.44
| Professional | | $1,348.96 | $1,949.84 | $3,388.44 |