- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,862.09 / $5,248.07 / $12,022.64
| Facility | | $1,862.09 | $5,248.07 | $12,022.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,778.28 / $2,187.76 / $4,570.88
| Professional | | $1,778.28 | $2,187.76 | $4,570.88 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,630.78 / $10,000.00 / $18,620.87
| Facility | | $3,630.78 | $10,000.00 | $18,620.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,698.24 / $2,454.71 / $4,897.79
| Professional | | $1,698.24 | $2,454.71 | $4,897.79 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $398.11 / $3,715.35 / $14,125.38
| Facility | | $398.11 | $3,715.35 | $14,125.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,862.09 / $2,884.03 / $6,309.57
| Professional | | $1,862.09 | $2,884.03 | $6,309.57 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,398.83 / $7,079.46 / $16,218.10
| Facility | | $2,398.83 | $7,079.46 | $16,218.10 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,621.81 / $2,290.87 / $4,466.84
| Professional | | $1,621.81 | $2,290.87 | $4,466.84 |