- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,540.44 / $2,278.57 / $2,351.54
| Facility | | $1,540.44 | $2,278.57 | $2,351.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,540.44 / $1,765.09 / $3,209.26
| Professional | | $1,540.44 | $1,765.09 | $3,209.26 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,371.72 / $3,540.31 / $15,563.86
| Facility | | $3,371.72 | $3,540.31 | $15,563.86 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,732.93 / $1,748.40 / $2,727.87
| Professional | | $1,732.93 | $1,748.40 | $2,727.87 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,289.62 / $2,289.62 / $2,289.62
| Facility | | $2,289.62 | $2,289.62 | $2,289.62 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,671.42 / $1,671.42 / $1,671.42
| Professional | | $1,671.42 | $1,671.42 | $1,671.42 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,540.44 / $2,717.33 / $15,617.77
| Facility | | $1,540.44 | $2,717.33 | $15,617.77 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,199.54 / $1,802.31 / $3,077.66
| Professional | | $1,199.54 | $1,802.31 | $3,077.66 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,199.54 / $1,682.11 / $2,493.60
| Professional | | $1,199.54 | $1,682.11 | $2,493.60 |