- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,862.09 / $4,677.35 / $11,481.54
| Facility | | $1,862.09 | $4,677.35 | $11,481.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,905.46 / $2,344.23 / $4,570.88
| Professional | | $1,905.46 | $2,344.23 | $4,570.88 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,388.44 / $8,709.64 / $16,982.44
| Facility | | $3,388.44 | $8,709.64 | $16,982.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,584.89 / $2,290.87 / $4,466.84
| Professional | | $1,584.89 | $2,290.87 | $4,466.84 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $371.54 / $3,715.35 / $10,471.29
| Facility | | $371.54 | $3,715.35 | $10,471.29 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,698.24 / $2,818.38 / $6,025.60
| Professional | | $1,698.24 | $2,818.38 | $6,025.60 |
- 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
- $1,737.80 / $2,398.83 / $4,466.84
| Professional | | $1,737.80 | $2,398.83 | $4,466.84 |