- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,819.70 / $4,897.79 / $11,748.98
| Facility | | $1,819.70 | $4,897.79 | $11,748.98 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,905.46 / $2,238.72 / $3,467.37
| Professional | | $1,905.46 | $2,238.72 | $3,467.37 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,162.28 / $7,762.47 / $15,488.17
| Facility | | $3,162.28 | $7,762.47 | $15,488.17 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $794.33 / $1,621.81 / $6,606.93
| Professional | | $794.33 | $1,621.81 | $6,606.93 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $398.11 / $3,311.31 / $11,748.98
| Facility | | $398.11 | $3,311.31 | $11,748.98 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $812.83 / $2,951.21 / $7,585.78
| Professional | | $812.83 | $2,951.21 | $7,585.78 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $537.03 / $2,818.38 / $9,549.93
| Facility | | $537.03 | $2,818.38 | $9,549.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,513.56 / $2,344.23 / $4,786.30
| Professional | | $1,513.56 | $2,344.23 | $4,786.30 |