- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,722.11 / $2,404.90 / $2,902.82
| Facility | | $1,722.11 | $2,404.90 | $2,902.82 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,864.73 / $2,527.84 / $3,268.15
| Professional | | $1,864.73 | $2,527.84 | $3,268.15 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $883.02 / $1,922.99 / $4,302.09
| Facility | | $883.02 | $1,922.99 | $4,302.09 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $663.34 / $1,690.11 / $3,787.78
| Professional | | $663.34 | $1,690.11 | $3,787.78 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $760.93 / $1,891.24 / $5,160.58
| Facility | | $760.93 | $1,891.24 | $5,160.58 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $399.36 / $643.42 / $1,057.34
| Professional | | $399.36 | $643.42 | $1,057.34 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,380.51 / $2,460.51 / $2,784.09
| Facility | | $2,380.51 | $2,460.51 | $2,784.09 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $549.77 / $1,681.78 / $3,761.63
| Professional | | $549.77 | $1,681.78 | $3,761.63 |