- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,704.66 / $3,922.46 / $6,856.65
| Facility | | $2,704.66 | $3,922.46 | $6,856.65 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,117.93 / $1,416.05 / $1,770.06
| Professional | | $1,117.93 | $1,416.05 | $1,770.06 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,384.92 / $5,366.07 / $8,990.78
| Facility | | $2,384.92 | $5,366.07 | $8,990.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,551.10 / $3,551.10 / $8,455.00
| Professional | | $3,551.10 | $3,551.10 | $8,455.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,065.76 / $1,247.42 / $5,692.12
| Facility | | $1,065.76 | $1,247.42 | $5,692.12 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,281.98 / $2,281.98 / $2,701.67
| Professional | | $2,281.98 | $2,281.98 | $2,701.67 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,416.05 / $1,863.22 / $2,608.51
| Facility | | $1,416.05 | $1,863.22 | $2,608.51 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,490.58 / $2,608.51 / $3,726.44
| Professional | | $1,490.58 | $2,608.51 | $3,726.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $782.55 / $782.55 / $1,117.93
| Professional | | $782.55 | $782.55 | $1,117.93 |