- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,587.04 / $4,470.00 / $12,154.00
| Facility | | $1,587.04 | $4,470.00 | $12,154.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,283.71 / $1,587.04 / $1,651.56
| Professional | | $1,283.71 | $1,587.04 | $1,651.56 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,088.00 / $4,279.00 / $10,043.00
| Facility | | $2,088.00 | $4,279.00 | $10,043.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,393.71 / $1,701.94 / $2,685.84
| Professional | | $1,393.71 | $1,701.94 | $2,685.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,248.86 / $1,873.31 / $3,520.63
| Professional | | $1,248.86 | $1,873.31 | $3,520.63 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $55.00 / $2,214.00 / $11,043.00
| Facility | | $55.00 | $2,214.00 | $11,043.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,391.61 / $2,601.75 / $18,481.68
| Professional | | $1,391.61 | $2,601.75 | $18,481.68 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,185.00 / $3,233.00 / $11,343.00
| Facility | | $1,185.00 | $3,233.00 | $11,343.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,310.36 / $2,055.98 / $3,913.14
| Professional | | $1,310.36 | $2,055.98 | $3,913.14 |