- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,071.52 / $5,128.61 / $7,762.47
| Facility | | $1,071.52 | $5,128.61 | $7,762.47 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $812.83 / $977.24 / $2,454.71
| Professional | | $812.83 | $977.24 | $2,454.71 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,000.00 / $4,677.35 / $10,715.19
| Professional | | $1,000.00 | $4,677.35 | $10,715.19 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $870.96 / $1,122.02 / $2,754.23
| Professional | | $870.96 | $1,122.02 | $2,754.23 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,023.29 / $2,041.74 / $2,454.71
| Professional | | $1,023.29 | $2,041.74 | $2,454.71 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,311.31 / $14,791.08 / $26,915.35
| Facility | | $3,311.31 | $14,791.08 | $26,915.35 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $758.58 / $1,000.00 / $2,290.87
| Professional | | $758.58 | $1,000.00 | $2,290.87 |