- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,981.07 / $5,128.61 / $19,054.61
| Facility | | $3,981.07 | $5,128.61 | $19,054.61 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,187.76 / $3,162.28 / $5,128.61
| Professional | | $2,187.76 | $3,162.28 | $5,128.61 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,715.35 / $6,760.83 / $10,000.00
| Facility | | $3,715.35 | $6,760.83 | $10,000.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $660.69 / $660.69 / $4,570.88
| Professional | | $660.69 | $660.69 | $4,570.88 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $39.81 / $39.81 / $3,715.35
| Facility | | $39.81 | $39.81 | $3,715.35 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,691.53 / $9,332.54 / $17,378.01
| Facility | | $2,691.53 | $9,332.54 | $17,378.01 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,621.81 / $3,801.89 / $7,244.36
| Professional | | $1,621.81 | $3,801.89 | $7,244.36 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,348.96 / $3,388.44 / $3,715.35
| Facility | | $1,348.96 | $3,388.44 | $3,715.35 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,230.27 / $1,737.80 / $4,365.16
| Professional | | $1,230.27 | $1,737.80 | $4,365.16 |