- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,229.49 / $3,359.50 / $7,879.32
| Facility | | $1,229.49 | $3,359.50 | $7,879.32 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,050.28 / $1,221.81 / $1,771.52
| Professional | | $1,050.28 | $1,221.81 | $1,771.52 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,318.17 / $4,733.93 / $8,281.00
| Facility | | $2,318.17 | $4,733.93 | $8,281.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,011.67 / $1,370.70 / $2,356.27
| Professional | | $1,011.67 | $1,370.70 | $2,356.27 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $680.00 / $870.49 / $1,323.47
| Facility | | $680.00 | $870.49 | $1,323.47 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $993.47 / $1,577.32 / $2,698.71
| Professional | | $993.47 | $1,577.32 | $2,698.71 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $815.50 / $2,335.00 / $5,253.50
| Facility | | $815.50 | $2,335.00 | $5,253.50 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,024.81 / $1,411.16 / $2,568.21
| Professional | | $1,024.81 | $1,411.16 | $2,568.21 |