- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,621.81 / $5,888.44 / $14,454.40
| Facility | | $1,621.81 | $5,888.44 | $14,454.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,202.26 / $1,412.54 / $3,090.30
| Professional | | $1,202.26 | $1,412.54 | $3,090.30 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,165.95 / $12,882.50 / $30,902.95
| Facility | | $6,165.95 | $12,882.50 | $30,902.95 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,202.26 / $1,819.70 / $3,715.35
| Professional | | $1,202.26 | $1,819.70 | $3,715.35 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,691.53 / $15,135.61 / $36,307.81
| Facility | | $2,691.53 | $15,135.61 | $36,307.81 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,380.38 / $2,137.96 / $4,265.80
| Professional | | $1,380.38 | $2,137.96 | $4,265.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,981.07 / $14,125.38 / $35,481.34
| Facility | | $3,981.07 | $14,125.38 | $35,481.34 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,202.26 / $1,698.24 / $3,090.30
| Professional | | $1,202.26 | $1,698.24 | $3,090.30 |