- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $645.65 / $645.65 / $5,011.87
| Facility | | $645.65 | $645.65 | $5,011.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $630.96 / $741.31 / $1,202.26
| Professional | | $630.96 | $741.31 | $1,202.26 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,073.80 / $14,791.08 / $33,884.42
| Facility | | $4,073.80 | $14,791.08 | $33,884.42 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,096.48 / $1,621.81 / $2,570.40
| Professional | | $1,096.48 | $1,621.81 | $2,570.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,819.70 / $2,570.40 / $6,165.95
| Facility | | $1,819.70 | $2,570.40 | $6,165.95 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,412.54 / $2,187.76 / $3,235.94
| Professional | | $1,412.54 | $2,187.76 | $3,235.94 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,995.26 / $2,454.71 / $4,786.30
| Facility | | $1,995.26 | $2,454.71 | $4,786.30 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,318.26 / $1,819.70 / $2,754.23
| Professional | | $1,318.26 | $1,819.70 | $2,754.23 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $912.01 / $1,412.54 / $9,332.54
| Facility | | $912.01 | $1,412.54 | $9,332.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $891.25 / $1,445.44 / $3,981.07
| Professional | | $891.25 | $1,445.44 | $3,981.07 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,311.31 / $6,456.54 / $18,620.87
| Facility | | $3,311.31 | $6,456.54 | $18,620.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $812.83 / $1,445.44 / $2,818.38
| Professional | | $812.83 | $1,445.44 | $2,818.38 |