- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,194.81 / $4,945.00 / $12,600.00
| Facility | | $2,194.81 | $4,945.00 | $12,600.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $410.02 / $1,349.99 / $2,447.69
| Professional | | $410.02 | $1,349.99 | $2,447.69 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $894.90 / $1,317.77 / $2,718.92
| Facility | | $894.90 | $1,317.77 | $2,718.92 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $553.24 / $553.24 / $2,135.21
| Professional | | $553.24 | $553.24 | $2,135.21 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $374.51 / $1,276.72 / $2,431.88
| Professional | | $374.51 | $1,276.72 | $2,431.88 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $418.42 / $1,845.00 / $8,348.00
| Facility | | $418.42 | $1,845.00 | $8,348.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,473.29 / $2,124.48 / $10,472.16
| Professional | | $1,473.29 | $2,124.48 | $10,472.16 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,779.00 / $3,647.00 / $6,239.00
| Facility | | $1,779.00 | $3,647.00 | $6,239.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,376.46 / $1,730.74 / $3,105.11
| Professional | | $1,376.46 | $1,730.74 | $3,105.11 |