- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,956.73 / $3,657.44 / $5,486.16
| Facility | | $1,956.73 | $3,657.44 | $5,486.16 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,011.59 / $2,251.96 / $7,974.62
| Professional | | $2,011.59 | $2,251.96 | $7,974.62 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,529.66 / $6,317.51 / $10,007.83
| Facility | | $1,529.66 | $6,317.51 | $10,007.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,238.58 / $1,801.58 / $11,632.83
| Professional | | $1,238.58 | $1,801.58 | $11,632.83 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,725.20 / $1,828.71 / $1,828.71
| Facility | | $1,725.20 | $1,828.71 | $1,828.71 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,828.71 / $1,828.71 / $1,828.71
| Professional | | $1,828.71 | $1,828.71 | $1,828.71 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,815.23 / $2,456.69 / $3,565.20
| Facility | | $1,815.23 | $2,456.69 | $3,565.20 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,861.13 / $1,861.13 / $1,861.13
| Professional | | $1,861.13 | $1,861.13 | $1,861.13 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,828.72 / $1,828.72 / $1,828.72
| Professional | | $1,828.72 | $1,828.72 | $1,828.72 |