- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,311.31 / $12,022.64 / $16,595.87
| Facility | | $3,311.31 | $12,022.64 | $16,595.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,000.00 / $1,318.26 / $3,311.31
| Professional | | $1,000.00 | $1,318.26 | $3,311.31 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,071.52 / $1,548.82 / $3,715.35
| Professional | | $1,071.52 | $1,548.82 | $3,715.35 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,122.02 / $1,584.89 / $4,265.80
| Facility | | $1,122.02 | $1,584.89 | $4,265.80 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,398.83 / $3,467.37 / $6,606.93
| Professional | | $2,398.83 | $3,467.37 | $6,606.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,691.53 / $4,466.84 / $6,456.54
| Professional | | $2,691.53 | $4,466.84 | $6,456.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,202.26 / $1,659.59 / $4,265.80
| Facility | | $1,202.26 | $1,659.59 | $4,265.80 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $60.26 / $1,621.81 / $3,715.35
| Professional | | $60.26 | $1,621.81 | $3,715.35 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,047.13 / $2,951.21 / $7,079.46
| Professional | | $1,047.13 | $2,951.21 | $7,079.46 |