- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,737.80 / $4,265.80 / $8,511.38
| Facility | | $1,737.80 | $4,265.80 | $8,511.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,318.26 / $1,621.81 / $4,265.80
| Professional | | $1,318.26 | $1,621.81 | $4,265.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,238.72 / $4,677.35 / $8,912.51
| Facility | | $2,238.72 | $4,677.35 | $8,912.51 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,513.56 / $1,862.09 / $2,884.03
| Professional | | $1,513.56 | $1,862.09 | $2,884.03 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,412.54 / $1,698.24 / $2,290.87
| Professional | | $1,412.54 | $1,698.24 | $2,290.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,445.44 / $2,041.74 / $3,311.31
| Professional | | $1,445.44 | $2,041.74 | $3,311.31 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,096.48 / $2,187.76 / $4,897.79
| Facility | | $1,096.48 | $2,187.76 | $4,897.79 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,479.11 / $2,137.96 / $11,220.18
| Professional | | $1,479.11 | $2,137.96 | $11,220.18 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,137.96 / $3,019.95 / $6,606.93
| Facility | | $2,137.96 | $3,019.95 | $6,606.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,380.38 / $1,819.70 / $2,884.03
| Professional | | $1,380.38 | $1,819.70 | $2,884.03 |