- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,078.09 / $1,078.09 / $6,907.45
| Facility | | $1,078.09 | $1,078.09 | $6,907.45 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $914.72 / $1,078.09 / $1,466.46
| Professional | | $914.72 | $1,078.09 | $1,466.46 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,358.81 / $2,884.46 / $6,035.45
| Facility | | $1,358.81 | $2,884.46 | $6,035.45 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,423.46 / $2,674.54 / $3,446.57
| Professional | | $1,423.46 | $2,674.54 | $3,446.57 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,509.94 / $3,559.42 / $8,562.66
| Facility | | $2,509.94 | $3,559.42 | $8,562.66 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,032.45 / $2,170.29 / $2,581.21
| Professional | | $2,032.45 | $2,170.29 | $2,581.21 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,280.59 / $3,254.16 / $6,742.25
| Facility | | $2,280.59 | $3,254.16 | $6,742.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,028.31 / $2,032.45 / $2,045.47
| Professional | | $2,028.31 | $2,032.45 | $2,045.47 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $966.31 / $1,690.20 / $2,943.94
| Facility | | $966.31 | $1,690.20 | $2,943.94 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,132.90 / $1,966.46 / $6,040.95
| Professional | | $1,132.90 | $1,966.46 | $6,040.95 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,147.78 / $1,938.77 / $3,378.99
| Professional | | $1,147.78 | $1,938.77 | $3,378.99 |