- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,365.16 / $5,754.40 / $10,964.78
| Facility | | $4,365.16 | $5,754.40 | $10,964.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,659.59 / $1,659.59 / $2,187.76
| Professional | | $1,659.59 | $1,659.59 | $2,187.76 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $223.87 / $295.12 / $575.44
| Facility | | $223.87 | $295.12 | $575.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,162.28 / $3,388.44 / $3,630.78
| Professional | | $3,162.28 | $3,388.44 | $3,630.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,630.27 / $4,168.69 / $5,248.07
| Professional | | $2,630.27 | $4,168.69 | $5,248.07 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $794.33 / $1,445.44 / $10,471.29
| Facility | | $794.33 | $1,445.44 | $10,471.29 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $933.25 / $1,318.26 / $6,309.57
| Professional | | $933.25 | $1,318.26 | $6,309.57 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,630.27 / $2,630.27 / $2,630.27
| Professional | | $2,630.27 | $2,630.27 | $2,630.27 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $933.25 / $2,089.30 / $4,365.16
| Facility | | $933.25 | $2,089.30 | $4,365.16 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,258.93 / $1,318.26 / $2,187.76
| Professional | | $1,258.93 | $1,318.26 | $2,187.76 |