- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,047.13 / $6,025.60 / $9,332.54
| Facility | | $1,047.13 | $6,025.60 | $9,332.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $724.44 / $794.33 / $1,380.38
| Professional | | $724.44 | $794.33 | $1,380.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $691.83 / $1,122.02 / $1,737.80
| Professional | | $691.83 | $1,122.02 | $1,737.80 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $32.36 / $33.11 / $1,659.59
| Professional | | $32.36 | $33.11 | $1,659.59 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,047.13 / $1,412.54 / $1,778.28
| Professional | | $1,047.13 | $1,412.54 | $1,778.28 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $691.83 / $1,258.93 / $1,659.59
| Professional | | $691.83 | $1,258.93 | $1,659.59 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,000.00 / $1,230.27 / $1,778.28
| Professional | | $1,000.00 | $1,230.27 | $1,778.28 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,290.87 / $5,128.61 / $13,803.84
| Facility | | $2,290.87 | $5,128.61 | $13,803.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $724.44 / $954.99 / $1,659.59
| Professional | | $724.44 | $954.99 | $1,659.59 |