- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,265.80 / $4,466.84 / $15,848.93
| Facility | | $4,265.80 | $4,466.84 | $15,848.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4,265.80 / $4,365.16 / $5,248.07
| Professional | | $4,265.80 | $4,365.16 | $5,248.07 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $0.02 / $1,737.80 / $5,370.32
| Facility | | $0.02 | $1,737.80 | $5,370.32 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,230.27 / $2,691.53 / $5,495.41
| Professional | | $1,230.27 | $2,691.53 | $5,495.41 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,466.84 / $4,466.84 / $5,248.07
| Facility | | $4,466.84 | $4,466.84 | $5,248.07 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,949.84 / $4,466.84 / $4,466.84
| Professional | | $1,949.84 | $4,466.84 | $4,466.84 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,737.80 / $1,737.80 / $3,548.13
| Facility | | $1,737.80 | $1,737.80 | $3,548.13 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5,248.07 / $5,248.07 / $5,888.44
| Professional | | $5,248.07 | $5,248.07 | $5,888.44 |