- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,339.25 / $2,335.91 / $4,671.81
| Facility | | $1,339.25 | $2,335.91 | $4,671.81 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $860.93 / $1,038.18 / $1,076.16
| Professional | | $860.93 | $1,038.18 | $1,076.16 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,440.00 / $3,798.21 / $6,873.49
| Facility | | $1,440.00 | $3,798.21 | $6,873.49 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,392.67 / $1,440.00 / $1,939.96
| Professional | | $1,392.67 | $1,440.00 | $1,939.96 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,266.07 / $1,645.89 / $2,025.71
| Facility | | $1,266.07 | $1,645.89 | $2,025.71 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,266.07 / $1,519.28 / $1,899.11
| Professional | | $1,266.07 | $1,519.28 | $1,899.11 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $822.95 / $2,392.82 / $4,938.13
| Facility | | $822.95 | $2,392.82 | $4,938.13 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,455.00 / $1,847.85 / $1,900.80
| Professional | | $1,455.00 | $1,847.85 | $1,900.80 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $531.75 / $759.64 / $1,391.41
| Professional | | $531.75 | $759.64 | $1,391.41 |