- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,311.31 / $12,022.64 / $16,595.87
| Facility | | $3,311.31 | $12,022.64 | $16,595.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,000.00 / $1,412.54 / $3,311.31
| Professional | | $1,000.00 | $1,412.54 | $3,311.31 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,754.23 / $3,715.35 / $4,786.30
| Professional | | $2,754.23 | $3,715.35 | $4,786.30 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,000.00 / $1,621.81 / $7,585.78
| Facility | | $1,000.00 | $1,621.81 | $7,585.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,570.40 / $3,801.89 / $5,754.40
| Professional | | $2,570.40 | $3,801.89 | $5,754.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,548.13 / $4,570.88 / $6,456.54
| Professional | | $3,548.13 | $4,570.88 | $6,456.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,047.13 / $1,621.81 / $6,025.60
| Facility | | $1,047.13 | $1,621.81 | $6,025.60 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $60.26 / $1,548.82 / $3,715.35
| Professional | | $60.26 | $1,548.82 | $3,715.35 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,258.93 / $5,128.61 / $6,456.54
| Professional | | $1,258.93 | $5,128.61 | $6,456.54 |