- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,096.48 / $2,344.23 / $4,897.79
| Facility | | $1,096.48 | $2,344.23 | $4,897.79 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,000.00 / $1,202.26 / $2,454.71
| Professional | | $1,000.00 | $1,202.26 | $2,454.71 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,232.93 / $25,703.96 / $35,481.34
| Facility | | $10,232.93 | $25,703.96 | $35,481.34 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,000.00 / $1,659.59 / $2,570.40
| Professional | | $1,000.00 | $1,659.59 | $2,570.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $933.25 / $1,023.29 / $1,122.02
| Facility | | $933.25 | $1,023.29 | $1,122.02 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,023.29 / $1,548.82 / $3,090.30
| Professional | | $1,023.29 | $1,548.82 | $3,090.30 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,456.54 / $13,182.57 / $20,417.38
| Facility | | $6,456.54 | $13,182.57 | $20,417.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $912.01 / $1,202.26 / $2,041.74
| Professional | | $912.01 | $1,202.26 | $2,041.74 |