- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,230.27 / $4,365.16 / $10,715.19
| Facility | | $1,230.27 | $4,365.16 | $10,715.19 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $912.01 / $1,071.52 / $2,398.83
| Professional | | $912.01 | $1,071.52 | $2,398.83 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,344.23 / $7,079.46 / $14,454.40
| Facility | | $2,344.23 | $7,079.46 | $14,454.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $831.76 / $1,230.27 / $2,454.71
| Professional | | $831.76 | $1,230.27 | $2,454.71 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,202.26 / $2,344.23 / $7,244.36
| Facility | | $1,202.26 | $2,344.23 | $7,244.36 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $933.25 / $1,445.44 / $3,162.28
| Professional | | $933.25 | $1,445.44 | $3,162.28 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,000.00 / $2,951.21 / $6,760.83
| Facility | | $1,000.00 | $2,951.21 | $6,760.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $812.83 / $1,148.15 / $2,238.72
| Professional | | $812.83 | $1,148.15 | $2,238.72 |