- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,000.00 / $2,598.76 / $7,838.38
| Facility | | $1,000.00 | $2,598.76 | $7,838.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,439.07 / $2,598.76 / $6,018.48
| Professional | | $2,439.07 | $2,598.76 | $6,018.48 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,765.53 / $4,148.29 / $5,238.39
| Professional | | $2,765.53 | $4,148.29 | $5,238.39 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $32.34 / $32.34 / $4,505.79
| Professional | | $32.34 | $32.34 | $4,505.79 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,636.87 / $3,224.81 / $4,286.57
| Facility | | $2,636.87 | $3,224.81 | $4,286.57 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,813.98 / $4,286.57 / $6,871.57
| Professional | | $2,813.98 | $4,286.57 | $6,871.57 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,657.00 / $21,608.00 / $23,542.00
| Facility | | $1,657.00 | $21,608.00 | $23,542.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,980.80 / $4,119.78 / $5,684.87
| Professional | | $2,980.80 | $4,119.78 | $5,684.87 |