- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,398.83 / $2,691.53 / $7,585.78
| Facility | | $2,398.83 | $2,691.53 | $7,585.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,698.24 / $1,949.84 / $3,311.31
| Professional | | $1,698.24 | $1,949.84 | $3,311.31 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $954.99 / $2,290.87 / $4,570.88
| Facility | | $954.99 | $2,290.87 | $4,570.88 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,905.46 / $2,818.38 / $4,265.80
| Professional | | $1,905.46 | $2,818.38 | $4,265.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $501.19 / $512.86 / $3,090.30
| Facility | | $501.19 | $512.86 | $3,090.30 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,698.24 / $2,398.83 / $4,073.80
| Professional | | $1,698.24 | $2,398.83 | $4,073.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $54.95 / $16,218.10 / $16,218.10
| Facility | | $54.95 | $16,218.10 | $16,218.10 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $13,182.57 / $15,135.61 / $15,135.61
| Professional | | $13,182.57 | $15,135.61 | $15,135.61 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,023.29 / $2,454.71 / $4,677.35
| Facility | | $1,023.29 | $2,454.71 | $4,677.35 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,548.82 / $2,137.96 / $3,548.13
| Professional | | $1,548.82 | $2,137.96 | $3,548.13 |