- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,288.25 / $4,365.16 / $10,964.78
| Facility | | $1,288.25 | $4,365.16 | $10,964.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,071.52 / $1,258.93 / $2,754.23
| Professional | | $1,071.52 | $1,258.93 | $2,754.23 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,290.87 / $5,248.07 / $11,220.18
| Facility | | $2,290.87 | $5,248.07 | $11,220.18 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,047.13 / $1,548.82 / $2,951.21
| Professional | | $1,047.13 | $1,548.82 | $2,951.21 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,000.00 / $2,089.30 / $8,709.64
| Facility | | $1,000.00 | $2,089.30 | $8,709.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,174.90 / $1,778.28 / $3,801.89
| Professional | | $1,174.90 | $1,778.28 | $3,801.89 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,348.96 / $4,073.80 / $9,549.93
| Facility | | $1,348.96 | $4,073.80 | $9,549.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,000.00 / $1,380.38 / $2,630.27
| Professional | | $1,000.00 | $1,380.38 | $2,630.27 |