- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,496.42 / $3,288.12 / $9,352.62
| Facility | | $1,496.42 | $3,288.12 | $9,352.62 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $935.26 / $935.26 / $1,082.23
| Professional | | $935.26 | $935.26 | $1,082.23 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,197.87 / $2,442.37 / $5,210.75
| Facility | | $2,197.87 | $2,442.37 | $5,210.75 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $534.44 / $868.45 / $868.46
| Professional | | $534.44 | $868.45 | $868.46 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,412.58 / $4,883.89 / $5,861.24
| Facility | | $2,412.58 | $4,883.89 | $5,861.24 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,336.09 / $1,813.34 / $4,123.84
| Professional | | $1,336.09 | $1,813.34 | $4,123.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $561.16 / $801.65 / $1,336.09
| Professional | | $561.16 | $801.65 | $1,336.09 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,500.00 / $2,750.00 / $3,500.00
| Professional | | $2,500.00 | $2,750.00 | $3,500.00 |