- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,862.09 / $5,623.41 / $11,748.98
| Facility | | $1,862.09 | $5,623.41 | $11,748.98 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4,466.84 / $5,370.32 / $10,000.00
| Professional | | $4,466.84 | $5,370.32 | $10,000.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,890.45 / $10,964.78 / $21,877.62
| Facility | | $3,890.45 | $10,964.78 | $21,877.62 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,511.89 / $5,011.87 / $10,232.93
| Professional | | $2,511.89 | $5,011.87 | $10,232.93 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $323.59 / $8,317.64 / $22,387.21
| Facility | | $323.59 | $8,317.64 | $22,387.21 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,454.71 / $6,456.54 / $13,182.57
| Professional | | $2,454.71 | $6,456.54 | $13,182.57 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $537.03 / $2,818.38 / $9,772.37
| Facility | | $537.03 | $2,818.38 | $9,772.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,715.35 / $5,495.41 / $10,232.93
| Professional | | $3,715.35 | $5,495.41 | $10,232.93 |