- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,380.38 / $6,760.83 / $8,709.64
| Facility | | $1,380.38 | $6,760.83 | $8,709.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,000.00 / $2,089.30 / $5,011.87
| Professional | | $1,000.00 | $2,089.30 | $5,011.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,819.70 / $2,630.27 / $3,890.45
| Professional | | $1,819.70 | $2,630.27 | $3,890.45 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,659.59 / $2,290.87 / $6,025.60
| Facility | | $1,659.59 | $2,290.87 | $6,025.60 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9,120.11 / $21,379.62 / $28,840.32
| Facility | | $9,120.11 | $21,379.62 | $28,840.32 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,023.29 / $1,513.56 / $3,311.31
| Professional | | $1,023.29 | $1,513.56 | $3,311.31 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $43,651.58 / $43,651.58 / $43,651.58
| Facility | | $43,651.58 | $43,651.58 | $43,651.58 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $38,904.51 / $46,773.51 / $46,773.51
| Professional | | $38,904.51 | $46,773.51 | $46,773.51 |