- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,380.17 / $1,380.17 / $10,614.91
| Facility | | $1,380.17 | $1,380.17 | $10,614.91 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $779.01 / $990.85 / $1,437.69
| Professional | | $779.01 | $990.85 | $1,437.69 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $893.59 / $1,145.56 / $1,698.04
| Professional | | $893.59 | $1,145.56 | $1,698.04 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,005.81 / $1,005.81 / $1,005.81
| Facility | | $1,005.81 | $1,005.81 | $1,005.81 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,101.31 / $1,607.25 / $1,923.75
| Professional | | $1,101.31 | $1,607.25 | $1,923.75 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,093.57 / $1,265.26 / $1,940.98
| Professional | | $1,093.57 | $1,265.26 | $1,940.98 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,614.91 / $10,614.91 / $10,614.91
| Facility | | $10,614.91 | $10,614.91 | $10,614.91 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $750.87 / $1,013.07 / $1,454.31
| Professional | | $750.87 | $1,013.07 | $1,454.31 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $866.80 / $1,256.10 / $1,624.28
| Professional | | $866.80 | $1,256.10 | $1,624.28 |