- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $954.99 / $6,025.60 / $14,454.40
| Facility | | $954.99 | $6,025.60 | $14,454.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $446.68 / $2,630.27 / $10,964.78
| Professional | | $446.68 | $2,630.27 | $10,964.78 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,630.78 / $7,413.10 / $21,379.62
| Facility | | $3,630.78 | $7,413.10 | $21,379.62 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $467.74 / $794.33 / $10,000.00
| Professional | | $467.74 | $794.33 | $10,000.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $524.81 / $8,128.31 / $42,657.95
| Facility | | $524.81 | $8,128.31 | $42,657.95 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $524.81 / $1,995.26 / $14,125.38
| Professional | | $524.81 | $1,995.26 | $14,125.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,951.21 / $8,709.64 / $20,417.38
| Facility | | $2,951.21 | $8,709.64 | $20,417.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $457.09 / $4,466.84 / $12,022.64
| Professional | | $457.09 | $4,466.84 | $12,022.64 |