- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,778.28 / $4,786.30 / $11,748.98
| Facility | | $1,778.28 | $4,786.30 | $11,748.98 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,511.89 / $2,951.21 / $5,495.41
| Professional | | $2,511.89 | $2,951.21 | $5,495.41 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,467.37 / $10,000.00 / $19,498.45
| Facility | | $3,467.37 | $10,000.00 | $19,498.45 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,344.23 / $3,090.30 / $5,888.44
| Professional | | $2,344.23 | $3,090.30 | $5,888.44 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $323.59 / $4,677.35 / $13,489.63
| Facility | | $323.59 | $4,677.35 | $13,489.63 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,187.76 / $3,715.35 / $7,585.78
| Professional | | $2,187.76 | $3,715.35 | $7,585.78 |
- 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
- $2,290.87 / $3,162.28 / $5,754.40
| Professional | | $2,290.87 | $3,162.28 | $5,754.40 |