- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,691.53 / $4,897.79 / $11,220.18
| Facility | | $2,691.53 | $4,897.79 | $11,220.18 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,348.96 / $4,073.80 / $17,782.79
| Professional | | $1,348.96 | $4,073.80 | $17,782.79 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,698.24 / $4,168.69 / $12,882.50
| Facility | | $1,698.24 | $4,168.69 | $12,882.50 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $724.44 / $851.14 / $4,265.80
| Professional | | $724.44 | $851.14 | $4,265.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,778.28 / $5,248.07 / $11,481.54
| Facility | | $1,778.28 | $5,248.07 | $11,481.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,348.96 / $3,311.31 / $6,606.93
| Professional | | $1,348.96 | $3,311.31 | $6,606.93 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,621.81 / $2,691.53 / $3,235.94
| Facility | | $1,621.81 | $2,691.53 | $3,235.94 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,148.15 / $1,621.81 / $3,235.94
| Professional | | $1,148.15 | $1,621.81 | $3,235.94 |