- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,202.26 / $4,570.88 / $11,748.98
| Facility | | $1,202.26 | $4,570.88 | $11,748.98 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,000.00 / $1,230.27 / $2,630.27
| Professional | | $1,000.00 | $1,230.27 | $2,630.27 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,630.78 / $9,332.54 / $17,378.01
| Facility | | $3,630.78 | $9,332.54 | $17,378.01 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $977.24 / $1,513.56 / $2,754.23
| Professional | | $977.24 | $1,513.56 | $2,754.23 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $398.11 / $2,754.23 / $7,585.78
| Facility | | $398.11 | $2,754.23 | $7,585.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,047.13 / $1,659.59 / $3,548.13
| Professional | | $1,047.13 | $1,659.59 | $3,548.13 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $851.14 / $3,162.28 / $10,232.93
| Facility | | $851.14 | $3,162.28 | $10,232.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $954.99 / $1,380.38 / $2,511.89
| Professional | | $954.99 | $1,380.38 | $2,511.89 |