- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,479.11 / $4,570.88 / $11,220.18
| Facility | | $1,479.11 | $4,570.88 | $11,220.18 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,348.96 / $1,621.81 / $3,388.44
| Professional | | $1,348.96 | $1,621.81 | $3,388.44 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,981.07 / $10,715.19 / $20,892.96
| Facility | | $3,981.07 | $10,715.19 | $20,892.96 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,318.26 / $1,995.26 / $3,630.78
| Professional | | $1,318.26 | $1,995.26 | $3,630.78 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $323.59 / $4,365.16 / $12,589.25
| Facility | | $323.59 | $4,365.16 | $12,589.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,412.54 / $2,238.72 / $4,786.30
| Professional | | $1,412.54 | $2,238.72 | $4,786.30 |
- 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
- $1,288.25 / $1,862.09 / $3,388.44
| Professional | | $1,288.25 | $1,862.09 | $3,388.44 |