- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,137.88 / $1,448.55 / $3,109.00
| Facility | | $1,137.88 | $1,448.55 | $3,109.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,063.09 / $1,275.51 / $1,498.35
| Professional | | $1,063.09 | $1,275.51 | $1,498.35 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,727.30 / $6,727.30 / $8,072.76
| Facility | | $6,727.30 | $6,727.30 | $8,072.76 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,288.72 / $1,610.89 / $1,705.65
| Professional | | $1,288.72 | $1,610.89 | $1,705.65 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,945.86 / $8,945.86 / $8,945.86
| Facility | | $8,945.86 | $8,945.86 | $8,945.86 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,178.15 / $1,734.50 / $2,256.03
| Professional | | $1,178.15 | $1,734.50 | $2,256.03 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,104.00 / $4,334.00 / $8,676.00
| Facility | | $2,104.00 | $4,334.00 | $8,676.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $962.82 / $1,269.17 / $2,216.96
| Professional | | $962.82 | $1,269.17 | $2,216.96 |