- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,479.11 / $1,819.70 / $3,890.45
| Facility | | $1,479.11 | $1,819.70 | $3,890.45 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,445.44 / $1,862.09 / $3,090.30
| Professional | | $1,445.44 | $1,862.09 | $3,090.30 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,513.56 / $2,041.74 / $7,762.47
| Facility | | $1,513.56 | $2,041.74 | $7,762.47 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,819.70 / $2,137.96 / $4,265.80
| Professional | | $1,819.70 | $2,137.96 | $4,265.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,398.83 / $2,398.83 / $13,803.84
| Facility | | $2,398.83 | $2,398.83 | $13,803.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,737.80 / $1,737.80 / $5,370.32
| Professional | | $1,737.80 | $1,737.80 | $5,370.32 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,862.09 / $2,511.89 / $4,466.84
| Facility | | $1,862.09 | $2,511.89 | $4,466.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,348.96 / $1,778.28 / $2,754.23
| Professional | | $1,348.96 | $1,778.28 | $2,754.23 |