- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,742.38 / $2,517.50 / $6,047.56
| Facility | | $1,742.38 | $2,517.50 | $6,047.56 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,404.50 / $1,742.38 / $1,855.00
| Professional | | $1,404.50 | $1,742.38 | $1,855.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $224.97 / $3,888.88 / $6,558.75
| Facility | | $224.97 | $3,888.88 | $6,558.75 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $623.74 / $810.47 / $1,749.00
| Professional | | $623.74 | $810.47 | $1,749.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,722.50 / $7,347.77 / $15,209.90
| Facility | | $1,722.50 | $7,347.77 | $15,209.90 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,047.50 / $4,828.30 / $6,545.50
| Professional | | $3,047.50 | $4,828.30 | $6,545.50 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,113.00 / $1,590.00 / $3,485.28
| Professional | | $1,113.00 | $1,590.00 | $3,485.28 |