- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,778.28 / $6,606.93 / $14,125.38
| Facility | | $1,778.28 | $6,606.93 | $14,125.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $275.42 / $831.76 / $2,290.87
| Professional | | $275.42 | $831.76 | $2,290.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $891.25 / $891.25 / $2,454.71
| Professional | | $891.25 | $891.25 | $2,454.71 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $309.03 / $1,000.00 / $6,165.95
| Facility | | $309.03 | $1,000.00 | $6,165.95 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $575.44 / $1,778.28 / $5,011.87
| Professional | | $575.44 | $1,778.28 | $5,011.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,023.29 / $1,819.70 / $4,265.80
| Professional | | $1,023.29 | $1,819.70 | $4,265.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $389.05 / $2,041.74 / $6,025.60
| Facility | | $389.05 | $2,041.74 | $6,025.60 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $60.26 / $354.81 / $2,454.71
| Professional | | $60.26 | $354.81 | $2,454.71 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $707.95 / $1,659.59 / $2,951.21
| Professional | | $707.95 | $1,659.59 | $2,951.21 |