- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,483.13 / $3,770.67 / $8,074.63
| Facility | | $1,483.13 | $3,770.67 | $8,074.63 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,336.41 / $1,511.82 / $2,534.67
| Professional | | $1,336.41 | $1,511.82 | $2,534.67 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,195.00 / $10,694.50 / $20,090.72
| Facility | | $5,195.00 | $10,694.50 | $20,090.72 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,497.51 / $1,811.47 / $2,937.24
| Professional | | $1,497.51 | $1,811.47 | $2,937.24 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,734.54 / $1,734.54 / $2,411.84
| Facility | | $1,734.54 | $1,734.54 | $2,411.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,482.66 / $2,167.42 / $3,547.13
| Professional | | $1,482.66 | $2,167.42 | $3,547.13 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,528.58 / $9,286.00 / $19,138.50
| Facility | | $5,528.58 | $9,286.00 | $19,138.50 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,467.68 / $2,008.33 / $3,400.16
| Professional | | $1,467.68 | $2,008.33 | $3,400.16 |