- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,137.96 / $10,964.78 / $16,595.87
| Facility | | $2,137.96 | $10,964.78 | $16,595.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $575.44 / $912.01 / $2,137.96
| Professional | | $575.44 | $912.01 | $2,137.96 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,778.28 / $2,398.83 / $3,162.28
| Professional | | $1,778.28 | $2,398.83 | $3,162.28 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $660.69 / $1,318.26 / $5,011.87
| Facility | | $660.69 | $1,318.26 | $5,011.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,737.80 / $2,511.89 / $3,801.89
| Professional | | $1,737.80 | $2,511.89 | $3,801.89 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,290.87 / $3,019.95 / $4,168.69
| Professional | | $2,290.87 | $3,019.95 | $4,168.69 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $676.08 / $1,288.25 / $3,890.45
| Facility | | $676.08 | $1,288.25 | $3,890.45 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $60.26 / $1,000.00 / $2,398.83
| Professional | | $60.26 | $1,000.00 | $2,398.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $812.83 / $2,884.03 / $4,168.69
| Professional | | $812.83 | $2,884.03 | $4,168.69 |