- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,466.84 / $7,413.10 / $11,748.98
| Facility | | $4,466.84 | $7,413.10 | $11,748.98 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $660.69 / $870.96 / $2,570.40
| Professional | | $660.69 | $870.96 | $2,570.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $776.25 / $1,096.48 / $2,238.72
| Professional | | $776.25 | $1,096.48 | $2,238.72 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $891.25 / $1,148.15 / $1,548.82
| Professional | | $891.25 | $1,148.15 | $1,548.82 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12,022.64 / $18,620.87 / $29,512.09
| Facility | | $12,022.64 | $18,620.87 | $29,512.09 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $660.69 / $912.01 / $1,949.84
| Professional | | $660.69 | $912.01 | $1,949.84 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,786.30 / $10,000.00 / $25,118.86
| Facility | | $4,786.30 | $10,000.00 | $25,118.86 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $602.56 / $831.76 / $1,479.11
| Professional | | $602.56 | $831.76 | $1,479.11 |