- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,362.34 / $7,388.14 / $21,014.60
| Facility | | $3,362.34 | $7,388.14 | $21,014.60 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,500.00 / $1,500.00 / $1,500.00
| Professional | | $1,500.00 | $1,500.00 | $1,500.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,938.43 / $5,487.82 / $11,708.15
| Facility | | $4,938.43 | $5,487.82 | $11,708.15 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,200.83 / $1,951.35 / $1,951.35
| Professional | | $1,200.83 | $1,951.35 | $1,951.35 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,420.88 / $10,974.40 / $13,169.73
| Facility | | $5,420.88 | $10,974.40 | $13,169.73 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,002.09 / $4,074.44 / $9,265.95
| Professional | | $3,002.09 | $4,074.44 | $9,265.95 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,260.88 / $1,801.25 / $3,002.09
| Professional | | $1,260.88 | $1,801.25 | $3,002.09 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,241.66 / $2,875.00 / $4,245.70
| Professional | | $2,241.66 | $2,875.00 | $4,245.70 |