- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,357.01 / $6,782.00 / $13,413.92
| Facility | | $1,357.01 | $6,782.00 | $13,413.92 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $300.23 / $596.49 / $2,301.54
| Professional | | $300.23 | $596.49 | $2,301.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $865.60 / $1,204.32 / $2,072.58
| Professional | | $865.60 | $1,204.32 | $2,072.58 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $436.45 / $1,873.40 / $3,222.16
| Facility | | $436.45 | $1,873.40 | $3,222.16 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $827.25 / $1,371.18 / $2,755.35
| Professional | | $827.25 | $1,371.18 | $2,755.35 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,278.75 / $1,934.55 / $2,866.00
| Professional | | $1,278.75 | $1,934.55 | $2,866.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $436.45 / $1,873.40 / $3,222.16
| Facility | | $436.45 | $1,873.40 | $3,222.16 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $700.56 / $1,848.15 / $2,845.05
| Professional | | $700.56 | $1,848.15 | $2,845.05 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,282.28 / $2,243.98 / $2,821.02
| Professional | | $1,282.28 | $2,243.98 | $2,821.02 |