- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,840.87 / $4,883.00 / $11,137.50
| Facility | | $1,840.87 | $4,883.00 | $11,137.50 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,279.39 / $1,767.16 / $2,192.76
| Professional | | $1,279.39 | $1,767.16 | $2,192.76 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,479.00 / $11,483.00 / $23,778.77
| Facility | | $8,479.00 | $11,483.00 | $23,778.77 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,515.08 / $1,553.94 / $1,955.53
| Professional | | $1,515.08 | $1,553.94 | $1,955.53 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,674.74 / $1,674.74 / $1,925.00
| Facility | | $1,674.74 | $1,674.74 | $1,925.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4,324.28 / $4,324.28 / $4,324.28
| Professional | | $4,324.28 | $4,324.28 | $4,324.28 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,580.50 / $17,246.50 / $43,955.50
| Facility | | $7,580.50 | $17,246.50 | $43,955.50 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,709.63 / $2,249.51 / $3,912.39
| Professional | | $1,709.63 | $2,249.51 | $3,912.39 |