- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,212.45 / $3,086.06 / $7,879.32
| Facility | | $1,212.45 | $3,086.06 | $7,879.32 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,032.53 / $1,200.92 / $1,837.29
| Professional | | $1,032.53 | $1,200.92 | $1,837.29 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,586.00 / $10,990.10 / $26,880.01
| Facility | | $4,586.00 | $10,990.10 | $26,880.01 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,121.80 / $1,602.57 / $2,587.63
| Professional | | $1,121.80 | $1,602.57 | $2,587.63 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $895.00 / $950.00 / $1,324.04
| Facility | | $895.00 | $950.00 | $1,324.04 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,165.30 / $1,743.07 / $2,552.20
| Professional | | $1,165.30 | $1,743.07 | $2,552.20 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,028.00 / $7,457.00 / $14,139.00
| Facility | | $3,028.00 | $7,457.00 | $14,139.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,087.70 / $1,546.44 / $2,514.34
| Professional | | $1,087.70 | $1,546.44 | $2,514.34 |