- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,659.59 / $5,754.40 / $10,471.29
| Facility | | $1,659.59 | $5,754.40 | $10,471.29 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,230.27 / $1,479.11 / $3,311.31
| Professional | | $1,230.27 | $1,479.11 | $3,311.31 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,380.38 / $1,737.80 / $3,388.44
| Professional | | $1,380.38 | $1,737.80 | $3,388.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,288.25 / $1,862.09 / $3,235.94
| Professional | | $1,288.25 | $1,862.09 | $3,235.94 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,230.27 / $1,621.81 / $2,691.53
| Facility | | $1,230.27 | $1,621.81 | $2,691.53 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,288.25 / $3,235.94 / $3,890.45
| Professional | | $1,288.25 | $3,235.94 | $3,890.45 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,466.84 / $12,302.69 / $19,054.61
| Facility | | $4,466.84 | $12,302.69 | $19,054.61 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,122.02 / $1,479.11 / $3,019.95
| Professional | | $1,122.02 | $1,479.11 | $3,019.95 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $21,379.62 / $21,379.62 / $33,884.42
| Facility | | $21,379.62 | $21,379.62 | $33,884.42 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $8,912.51 / $8,912.51 / $10,471.29
| Professional | | $8,912.51 | $8,912.51 | $10,471.29 |