- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,964.08 / $13,413.92 / $20,143.00
| Facility | | $3,964.08 | $13,413.92 | $20,143.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,356.04 / $1,497.81 / $7,247.09
| Professional | | $1,356.04 | $1,497.81 | $7,247.09 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,327.92 / $2,071.44 / $4,620.04
| Professional | | $1,327.92 | $2,071.44 | $4,620.04 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,374.61 / $7,247.09 / $10,145.93
| Facility | | $1,374.61 | $7,247.09 | $10,145.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,348.68 / $5,002.89 / $9,243.52
| Professional | | $3,348.68 | $5,002.89 | $9,243.52 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,632.72 / $6,432.00 / $10,217.92
| Professional | | $3,632.72 | $6,432.00 | $10,217.92 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,374.61 / $7,247.09 / $10,145.93
| Facility | | $1,374.61 | $7,247.09 | $10,145.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,626.07 / $4,928.39 / $8,826.34
| Professional | | $1,626.07 | $4,928.39 | $8,826.34 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,841.44 / $3,696.02 / $10,194.87
| Professional | | $1,841.44 | $3,696.02 | $10,194.87 |