- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,100.18 / $2,750.45 / $11,873.60
| Facility | | $1,100.18 | $2,750.45 | $11,873.60 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,100.18 / $1,362.35 / $1,764.43
| Professional | | $1,100.18 | $1,362.35 | $1,764.43 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,029.09 / $2,625.89 / $7,001.29
| Facility | | $2,029.09 | $2,625.89 | $7,001.29 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,100.17 / $2,385.08 / $2,981.34
| Professional | | $1,100.17 | $2,385.08 | $2,981.34 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $830.32 / $1,037.90 / $1,245.48
| Professional | | $830.32 | $1,037.90 | $1,245.48 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,453.06 / $1,453.06 / $8,702.00
| Facility | | $1,453.06 | $1,453.06 | $8,702.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,453.06 / $1,453.06 / $1,453.06
| Professional | | $1,453.06 | $1,453.06 | $1,453.06 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $803.69 / $1,245.48 / $2,127.69
| Professional | | $803.69 | $1,245.48 | $2,127.69 |