- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,418.11 / $3,650.50 / $8,074.63
| Facility | | $1,418.11 | $3,650.50 | $8,074.63 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,260.98 / $1,474.94 / $2,068.13
| Professional | | $1,260.98 | $1,474.94 | $2,068.13 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,247.00 / $8,490.10 / $13,628.92
| Facility | | $4,247.00 | $8,490.10 | $13,628.92 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,240.83 / $1,715.00 / $2,484.13
| Professional | | $1,240.83 | $1,715.00 | $2,484.13 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,432.39 / $1,432.39 / $4,026.19
| Facility | | $1,432.39 | $1,432.39 | $4,026.19 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,358.47 / $1,906.91 / $3,031.05
| Professional | | $1,358.47 | $1,906.91 | $3,031.05 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,403.00 / $3,325.00 / $8,152.00
| Facility | | $1,403.00 | $3,325.00 | $8,152.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,278.45 / $1,832.26 / $3,245.08
| Professional | | $1,278.45 | $1,832.26 | $3,245.08 |