- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,162.28 / $12,022.64 / $16,595.87
| Facility | | $3,162.28 | $12,022.64 | $16,595.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $977.24 / $1,230.27 / $3,162.28
| Professional | | $977.24 | $1,230.27 | $3,162.28 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,000.00 / $1,412.54 / $3,467.37
| Professional | | $1,000.00 | $1,412.54 | $3,467.37 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,047.13 / $1,513.56 / $3,981.07
| Facility | | $1,047.13 | $1,513.56 | $3,981.07 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,089.30 / $3,090.30 / $5,888.44
| Professional | | $2,089.30 | $3,090.30 | $5,888.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,570.40 / $4,168.69 / $6,165.95
| Professional | | $2,570.40 | $4,168.69 | $6,165.95 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,122.02 / $1,513.56 / $3,981.07
| Facility | | $1,122.02 | $1,513.56 | $3,981.07 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $60.26 / $1,548.82 / $3,467.37
| Professional | | $60.26 | $1,548.82 | $3,467.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $954.99 / $2,754.23 / $6,606.93
| Professional | | $954.99 | $2,754.23 | $6,606.93 |