- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $977.24 / $2,454.71 / $3,235.94
| Facility | | $977.24 | $2,454.71 | $3,235.94 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $870.96 / $977.24 / $1,230.27
| Professional | | $870.96 | $977.24 | $1,230.27 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,248.07 / $6,760.83 / $8,128.31
| Facility | | $5,248.07 | $6,760.83 | $8,128.31 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $851.14 / $1,148.15 / $1,445.44
| Professional | | $851.14 | $1,148.15 | $1,445.44 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,318.26 / $3,235.94 / $6,760.83
| Facility | | $1,318.26 | $3,235.94 | $6,760.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $549.54 / $1,513.56 / $1,862.09
| Professional | | $549.54 | $1,513.56 | $1,862.09 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,318.26 / $1,548.82 / $1,949.84
| Professional | | $1,318.26 | $1,548.82 | $1,949.84 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $776.25 / $1,023.29 / $1,513.56
| Facility | | $776.25 | $1,023.29 | $1,513.56 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,071.52 / $1,071.52 / $2,754.23
| Professional | | $1,071.52 | $1,071.52 | $2,754.23 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $912.01 / $1,445.44 / $3,311.31
| Facility | | $912.01 | $1,445.44 | $3,311.31 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $912.01 / $1,479.11 / $3,311.31
| Professional | | $912.01 | $1,479.11 | $3,311.31 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $549.54 / $1,318.26 / $1,548.82
| Facility | | $549.54 | $1,318.26 | $1,548.82 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $549.54 / $588.84 / $977.24
| Professional | | $549.54 | $588.84 | $977.24 |