- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,721.46 / $3,782.61 / $10,759.10
| Facility | | $1,721.46 | $3,782.61 | $10,759.10 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,075.91 / $1,075.91 / $1,244.99
| Professional | | $1,075.91 | $1,075.91 | $1,244.99 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,528.40 / $2,809.67 / $5,994.38
| Facility | | $2,528.40 | $2,809.67 | $5,994.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $614.80 / $999.06 / $999.06
| Professional | | $614.80 | $999.06 | $999.06 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,775.39 / $5,618.88 / $6,742.66
| Facility | | $2,775.39 | $5,618.88 | $6,742.66 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,537.02 / $2,086.04 / $4,744.01
| Professional | | $1,537.02 | $2,086.04 | $4,744.01 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $645.54 / $922.21 / $1,537.02
| Professional | | $645.54 | $922.21 | $1,537.02 |
- 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 |