- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,685.51 / $4,123.05 / $5,497.40
| Facility | | $2,685.51 | $4,123.05 | $5,497.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,401.16 / $2,717.10 / $3,064.64
| Professional | | $2,401.16 | $2,717.10 | $3,064.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $500.00 / $2,409.67 / $5,821.71
| Professional | | $500.00 | $2,409.67 | $5,821.71 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,351.62 / $6,101.31 / $7,530.62
| Facility | | $4,351.62 | $6,101.31 | $7,530.62 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,666.57 / $3,666.57 / $3,666.57
| Professional | | $3,666.57 | $3,666.57 | $3,666.57 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,685.51 / $3,791.30 / $15,007.25
| Facility | | $2,685.51 | $3,791.30 | $15,007.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,326.96 / $1,895.65 / $15,733.91
| Professional | | $1,326.96 | $1,895.65 | $15,733.91 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,137.39 / $3,159.42 / $3,791.30
| Facility | | $1,137.39 | $3,159.42 | $3,791.30 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,326.96 / $1,895.65 / $3,573.30
| Professional | | $1,326.96 | $1,895.65 | $3,573.30 |