- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,621.81 / $4,897.79 / $11,481.54
| Facility | | $1,621.81 | $4,897.79 | $11,481.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,148.15 / $1,819.70 / $3,019.95
| Professional | | $1,148.15 | $1,819.70 | $3,019.95 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,570.40 / $4,570.88 / $13,182.57
| Facility | | $2,570.40 | $4,570.88 | $13,182.57 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $138.04 / $1,905.46 / $3,548.13
| Professional | | $138.04 | $1,905.46 | $3,548.13 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,398.83 / $19,498.45 / $53,703.18
| Facility | | $2,398.83 | $19,498.45 | $53,703.18 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $6,760.83 / $7,079.46 / $8,511.38
| Professional | | $6,760.83 | $7,079.46 | $8,511.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,584.89 / $4,265.80 / $10,000.00
| Facility | | $1,584.89 | $4,265.80 | $10,000.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,621.81 / $2,398.83 / $4,168.69
| Professional | | $1,621.81 | $2,398.83 | $4,168.69 |