- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,471.14 / $10,900.00 / $14,552.94
| Facility | | $1,471.14 | $10,900.00 | $14,552.94 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $478.31 / $2,430.31 / $2,430.31
| Professional | | $478.31 | $2,430.31 | $2,430.31 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,258.08 / $1,684.64 / $2,200.14
| Professional | | $1,258.08 | $1,684.64 | $2,200.14 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $489.09 / $2,430.31 / $3,402.43
| Facility | | $489.09 | $2,430.31 | $3,402.43 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,271.23 / $1,525.47 / $3,096.84
| Professional | | $1,271.23 | $1,525.47 | $3,096.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,635.70 / $2,279.40 / $2,940.00
| Professional | | $1,635.70 | $2,279.40 | $2,940.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $489.09 / $2,430.31 / $3,402.43
| Facility | | $489.09 | $2,430.31 | $3,402.43 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $762.44 / $2,278.50 / $3,358.95
| Professional | | $762.44 | $2,278.50 | $3,358.95 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,337.40 / $2,033.15 / $3,066.02
| Professional | | $1,337.40 | $2,033.15 | $3,066.02 |