- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $891.25 / $891.25 / $7,079.46
| Facility | | $891.25 | $891.25 | $7,079.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $812.83 / $912.01 / $1,445.44
| Professional | | $812.83 | $912.01 | $1,445.44 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,370.32 / $14,125.38 / $32,359.37
| Facility | | $5,370.32 | $14,125.38 | $32,359.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,445.44 / $2,187.76 / $3,311.31
| Professional | | $1,445.44 | $2,187.76 | $3,311.31 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,290.87 / $3,235.94 / $7,762.47
| Facility | | $2,290.87 | $3,235.94 | $7,762.47 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,584.89 / $2,630.27 / $3,981.07
| Professional | | $1,584.89 | $2,630.27 | $3,981.07 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,511.89 / $3,090.30 / $6,165.95
| Facility | | $2,511.89 | $3,090.30 | $6,165.95 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,698.24 / $2,238.72 / $3,548.13
| Professional | | $1,698.24 | $2,238.72 | $3,548.13 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $912.01 / $1,819.70 / $10,471.29
| Facility | | $912.01 | $1,819.70 | $10,471.29 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $851.14 / $1,659.59 / $4,897.79
| Professional | | $851.14 | $1,659.59 | $4,897.79 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,235.94 / $6,309.57 / $12,589.25
| Facility | | $3,235.94 | $6,309.57 | $12,589.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $870.96 / $1,584.89 / $3,235.94
| Professional | | $870.96 | $1,584.89 | $3,235.94 |