- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,758.68 / $3,649.26 / $4,818.78
| Facility | | $1,758.68 | $3,649.26 | $4,818.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,461.90 / $1,758.68 / $1,868.60
| Professional | | $1,461.90 | $1,758.68 | $1,868.60 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,670.42 / $2,143.40 / $5,771.02
| Facility | | $1,670.42 | $2,143.40 | $5,771.02 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,758.68 / $2,198.35 / $3,297.53
| Facility | | $1,758.68 | $2,198.35 | $3,297.53 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,428.93 / $1,428.93 / $2,198.35
| Professional | | $1,428.93 | $1,428.93 | $2,198.35 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,418.17 / $3,363.48 / $4,209.84
| Professional | | $2,418.17 | $3,363.48 | $4,209.84 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,638.02 / $2,638.02 / $2,638.02
| Facility | | $2,638.02 | $2,638.02 | $2,638.02 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,099.18 / $1,319.01 / $2,264.30
| Professional | | $1,099.18 | $1,319.01 | $2,264.30 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,825.13 / $10,442.16 / $10,442.16
| Facility | | $3,825.13 | $10,442.16 | $10,442.16 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $10,947.78 / $10,947.78 / $16,487.63
| Professional | | $10,947.78 | $10,947.78 | $16,487.63 |