- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,621.81 / $4,897.79 / $17,378.01
| Facility | | $1,621.81 | $4,897.79 | $17,378.01 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,380.38 / $1,513.56 / $2,454.71
| Professional | | $1,380.38 | $1,513.56 | $2,454.71 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,623.41 / $18,197.01 / $26,302.68
| Facility | | $5,623.41 | $18,197.01 | $26,302.68 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,258.93 / $1,513.56 / $2,454.71
| Professional | | $1,258.93 | $1,513.56 | $2,454.71 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,479.11 / $1,548.82 / $1,737.80
| Facility | | $1,479.11 | $1,548.82 | $1,737.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,548.82 / $2,398.83 / $3,090.30
| Facility | | $1,548.82 | $2,398.83 | $3,090.30 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,258.93 / $1,862.09 / $3,311.31
| Professional | | $1,258.93 | $1,862.09 | $3,311.31 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,466.84 / $9,549.93 / $16,218.10
| Facility | | $4,466.84 | $9,549.93 | $16,218.10 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,318.26 / $1,659.59 / $2,691.53
| Professional | | $1,318.26 | $1,659.59 | $2,691.53 |