- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,386.06 / $3,642.26 / $7,879.32
| Facility | | $1,386.06 | $3,642.26 | $7,879.32 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,238.09 / $1,447.06 / $2,251.80
| Professional | | $1,238.09 | $1,447.06 | $2,251.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,114.84 / $8,805.92 / $14,433.40
| Facility | | $4,114.84 | $8,805.92 | $14,433.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,259.24 / $1,627.02 / $2,784.74
| Professional | | $1,259.24 | $1,627.02 | $2,784.74 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $680.00 / $870.49 / $1,568.87
| Facility | | $680.00 | $870.49 | $1,568.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,290.19 / $1,882.74 / $3,230.39
| Professional | | $1,290.19 | $1,882.74 | $3,230.39 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $718.00 / $2,575.00 / $7,326.50
| Facility | | $718.00 | $2,575.00 | $7,326.50 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,220.29 / $1,679.45 / $3,008.93
| Professional | | $1,220.29 | $1,679.45 | $3,008.93 |