- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,687.44 / $3,772.57 / $8,074.63
| Facility | | $1,687.44 | $3,772.57 | $8,074.63 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,514.17 / $1,846.19 / $2,537.73
| Professional | | $1,514.17 | $1,846.19 | $2,537.73 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,470.00 / $9,458.00 / $17,400.00
| Facility | | $5,470.00 | $9,458.00 | $17,400.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,514.33 / $1,980.67 / $3,062.69
| Professional | | $1,514.33 | $1,980.67 | $3,062.69 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,747.52 / $1,747.52 / $4,708.97
| Facility | | $1,747.52 | $1,747.52 | $4,708.97 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,604.77 / $2,256.54 / $3,723.32
| Professional | | $1,604.77 | $2,256.54 | $3,723.32 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,367.00 / $3,236.00 / $6,792.00
| Facility | | $1,367.00 | $3,236.00 | $6,792.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,507.64 / $2,165.15 / $3,919.57
| Professional | | $1,507.64 | $2,165.15 | $3,919.57 |