- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,122.02 / $5,248.07 / $12,589.25
| Facility | | $1,122.02 | $5,248.07 | $12,589.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $660.69 / $776.25 / $1,949.84
| Professional | | $660.69 | $776.25 | $1,949.84 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,818.38 / $6,456.54 / $14,125.38
| Facility | | $2,818.38 | $6,456.54 | $14,125.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $676.08 / $1,000.00 / $1,819.70
| Professional | | $676.08 | $1,000.00 | $1,819.70 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $398.11 / $1,479.11 / $5,248.07
| Facility | | $398.11 | $1,479.11 | $5,248.07 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $724.44 / $1,096.48 / $2,290.87
| Professional | | $724.44 | $1,096.48 | $2,290.87 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,905.46 / $5,754.40 / $14,125.38
| Facility | | $1,905.46 | $5,754.40 | $14,125.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $616.60 / $870.96 / $1,621.81
| Professional | | $616.60 | $870.96 | $1,621.81 |