- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,698.24 / $4,570.88 / $7,244.36
| Facility | | $1,698.24 | $4,570.88 | $7,244.36 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,698.24 / $2,089.30 / $2,511.89
| Professional | | $1,698.24 | $2,089.30 | $2,511.89 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,290.87 / $3,311.31 / $10,000.00
| Facility | | $2,290.87 | $3,311.31 | $10,000.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,570.40 / $2,570.40 / $4,786.30
| Professional | | $2,570.40 | $2,570.40 | $4,786.30 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,981.07 / $5,623.41 / $7,762.47
| Facility | | $3,981.07 | $5,623.41 | $7,762.47 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $14,454.40 / $14,454.40 / $14,454.40
| Professional | | $14,454.40 | $14,454.40 | $14,454.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,290.87 / $2,818.38 / $3,630.78
| Professional | | $2,290.87 | $2,818.38 | $3,630.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,570.40 / $3,467.37 / $5,495.41
| Professional | | $2,570.40 | $3,467.37 | $5,495.41 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,290.87 / $2,290.87 / $2,570.40
| Facility | | $2,290.87 | $2,290.87 | $2,570.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,071.52 / $1,548.82 / $3,548.13
| Professional | | $1,071.52 | $1,548.82 | $3,548.13 |