- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,000.00 / $4,073.80 / $7,762.47
| Facility | | $1,000.00 | $4,073.80 | $7,762.47 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $812.83 / $933.25 / $2,187.76
| Professional | | $812.83 | $933.25 | $2,187.76 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $933.25 / $2,398.83 / $7,943.28
| Professional | | $933.25 | $2,398.83 | $7,943.28 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $933.25 / $1,479.11 / $2,691.53
| Professional | | $933.25 | $1,479.11 | $2,691.53 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $954.99 / $1,819.70 / $2,187.76
| Professional | | $954.99 | $1,819.70 | $2,187.76 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,311.31 / $13,489.63 / $26,915.35
| Facility | | $3,311.31 | $13,489.63 | $26,915.35 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $645.65 / $1,202.26 / $2,570.40
| Professional | | $645.65 | $1,202.26 | $2,570.40 |