- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,133.97 / $3,079.96 / $7,879.32
| Facility | | $1,133.97 | $3,079.96 | $7,879.32 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,007.18 / $1,152.19 / $1,768.85
| Professional | | $1,007.18 | $1,152.19 | $1,768.85 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,586.00 / $15,041.04 / $39,007.80
| Facility | | $4,586.00 | $15,041.04 | $39,007.80 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,059.63 / $1,385.90 / $2,263.33
| Professional | | $1,059.63 | $1,385.90 | $2,263.33 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $895.00 / $950.00 / $1,273.55
| Facility | | $895.00 | $950.00 | $1,273.55 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,132.82 / $1,612.96 / $2,463.87
| Professional | | $1,132.82 | $1,612.96 | $2,463.87 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,017.50 / $7,077.50 / $14,355.11
| Facility | | $3,017.50 | $7,077.50 | $14,355.11 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,018.18 / $1,470.88 / $2,480.15
| Professional | | $1,018.18 | $1,470.88 | $2,480.15 |