- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,642.50 / $4,510.50 / $8,572.13
| Facility | | $2,642.50 | $4,510.50 | $8,572.13 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,532.64 / $2,880.31 / $4,393.87
| Professional | | $2,532.64 | $2,880.31 | $4,393.87 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,586.00 / $18,409.41 / $39,007.80
| Facility | | $4,586.00 | $18,409.41 | $39,007.80 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,494.00 / $3,346.15 / $5,453.97
| Professional | | $2,494.00 | $3,346.15 | $5,453.97 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $895.00 / $950.00 / $3,176.17
| Facility | | $895.00 | $950.00 | $3,176.17 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,699.42 / $3,967.72 / $6,226.11
| Professional | | $2,699.42 | $3,967.72 | $6,226.11 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,028.00 / $7,457.00 / $14,139.00
| Facility | | $3,028.00 | $7,457.00 | $14,139.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,509.31 / $3,515.40 / $6,188.29
| Professional | | $2,509.31 | $3,515.40 | $6,188.29 |