- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,547.39 / $3,868.48 / $16,700.09
| Facility | | $1,547.39 | $3,868.48 | $16,700.09 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,547.39 / $2,277.29 / $2,481.66
| Professional | | $1,547.39 | $2,277.29 | $2,481.66 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,853.91 / $6,435.03 / $13,378.63
| Facility | | $2,853.91 | $6,435.03 | $13,378.63 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,335.67 / $2,335.67 / $2,335.67
| Professional | | $2,335.67 | $2,335.67 | $2,335.67 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,065.58 / $3,824.68 / $5,319.51
| Professional | | $3,065.58 | $3,824.68 | $5,319.51 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,165.00 / $13,785.00 / $13,785.00
| Facility | | $1,165.00 | $13,785.00 | $13,785.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,372.21 / $2,919.60 / $5,992.68
| Facility | | $1,372.21 | $2,919.60 | $5,992.68 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,167.83 / $1,751.76 / $2,977.99
| Professional | | $1,167.83 | $1,751.76 | $2,977.99 |