- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,570.88 / $8,912.51 / $14,791.08
| Facility | | $4,570.88 | $8,912.51 | $14,791.08 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,096.48 / $1,445.44 / $3,548.13
| Professional | | $1,096.48 | $1,445.44 | $3,548.13 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,317.64 / $14,791.08 / $16,595.87
| Facility | | $8,317.64 | $14,791.08 | $16,595.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,148.15 / $2,454.71 / $3,311.31
| Professional | | $1,148.15 | $2,454.71 | $3,311.31 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,445.44 / $2,137.96 / $3,019.95
| Professional | | $1,445.44 | $2,137.96 | $3,019.95 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,187.76 / $2,187.76 / $2,238.72
| Professional | | $2,187.76 | $2,187.76 | $2,238.72 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,456.54 / $10,471.29 / $16,218.10
| Facility | | $6,456.54 | $10,471.29 | $16,218.10 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,318.26 / $1,737.80 / $3,311.31
| Professional | | $1,318.26 | $1,737.80 | $3,311.31 |