- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,661.63 / $3,881.23 / $8,074.63
| Facility | | $1,661.63 | $3,881.23 | $8,074.63 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,570.22 / $1,820.72 / $2,711.63
| Professional | | $1,570.22 | $1,820.72 | $2,711.63 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,195.00 / $10,577.77 / $19,959.86
| Facility | | $5,195.00 | $10,577.77 | $19,959.86 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,579.85 / $1,982.43 / $3,315.16
| Professional | | $1,579.85 | $1,982.43 | $3,315.16 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,823.81 / $1,823.81 / $2,509.12
| Facility | | $1,823.81 | $1,823.81 | $2,509.12 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,635.46 / $2,396.56 / $3,877.72
| Professional | | $1,635.46 | $2,396.56 | $3,877.72 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,403.00 / $3,325.00 / $8,198.00
| Facility | | $1,403.00 | $3,325.00 | $8,198.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,593.57 / $2,191.44 / $3,806.72
| Professional | | $1,593.57 | $2,191.44 | $3,806.72 |