- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,786.30 / $4,786.30 / $7,079.46
| Facility | | $4,786.30 | $4,786.30 | $7,079.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5,370.32 / $6,760.83 / $7,585.78
| Professional | | $5,370.32 | $6,760.83 | $7,585.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4,677.35 / $6,309.57 / $6,309.57
| Professional | | $4,677.35 | $6,309.57 | $6,309.57 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $676.08 / $1,513.56 / $14,125.38
| Facility | | $676.08 | $1,513.56 | $14,125.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,047.13 / $1,698.24 / $20,417.38
| Professional | | $1,047.13 | $1,698.24 | $20,417.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,258.93 / $7,079.46 / $8,317.64
| Facility | | $1,258.93 | $7,079.46 | $8,317.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $812.83 / $6,606.93 / $7,943.28
| Professional | | $812.83 | $6,606.93 | $7,943.28 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $616.60 / $1,122.02 / $6,456.54
| Professional | | $616.60 | $1,122.02 | $6,456.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $524.81 / $794.33 / $5,248.07
| Facility | | $524.81 | $794.33 | $5,248.07 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,398.83 / $3,715.35 / $5,754.40
| Professional | | $2,398.83 | $3,715.35 | $5,754.40 |