- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,678.03 / $1,678.03 / $2,480.57
| Facility | | $1,678.03 | $1,678.03 | $2,480.57 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,690.21 / $1,974.38 / $2,638.10
| Professional | | $1,690.21 | $1,974.38 | $2,638.10 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,179.23 / $2,779.02 / $2,847.77
| Professional | | $2,179.23 | $2,779.02 | $2,847.77 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $295.43 / $506.43 / $4,173.39
| Facility | | $295.43 | $506.43 | $4,173.39 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $311.83 / $541.61 / $6,051.42
| Professional | | $311.83 | $541.61 | $6,051.42 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,253.42 / $2,416.31 / $3,744.63
| Facility | | $2,253.42 | $2,416.31 | $3,744.63 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $257.99 / $2,053.86 / $2,416.31
| Professional | | $257.99 | $2,053.86 | $2,416.31 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $190.12 / $265.31 / $2,653.18
| Professional | | $190.12 | $265.31 | $2,653.18 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $844.13 / $1,675.16 / $2,386.46
| Professional | | $844.13 | $1,675.16 | $2,386.46 |