- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,778.28 / $2,290.87 / $3,981.07
| Facility | | $1,778.28 | $2,290.87 | $3,981.07 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,778.28 / $2,290.87 / $3,890.45
| Professional | | $1,778.28 | $2,290.87 | $3,890.45 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,862.09 / $2,511.89 / $9,772.37
| Facility | | $1,862.09 | $2,511.89 | $9,772.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,290.87 / $2,570.40 / $5,128.61
| Professional | | $2,290.87 | $2,570.40 | $5,128.61 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,570.40 / $2,570.40 / $17,378.01
| Facility | | $2,570.40 | $2,570.40 | $17,378.01 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,862.09 / $1,862.09 / $6,606.93
| Professional | | $1,862.09 | $1,862.09 | $6,606.93 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,290.87 / $3,162.28 / $5,495.41
| Facility | | $2,290.87 | $3,162.28 | $5,495.41 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,621.81 / $2,187.76 / $3,388.44
| Professional | | $1,621.81 | $2,187.76 | $3,388.44 |