- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,202.26 / $5,128.61 / $7,413.10
| Facility | | $1,202.26 | $5,128.61 | $7,413.10 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,000.00 / $1,071.52 / $2,691.53
| Professional | | $1,000.00 | $1,071.52 | $2,691.53 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $251.19 / $416.87 / $2,290.87
| Facility | | $251.19 | $416.87 | $2,290.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,318.26 / $1,905.46 / $3,981.07
| Professional | | $1,318.26 | $1,905.46 | $3,981.07 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $363.08 / $1,584.89 / $2,344.23
| Facility | | $363.08 | $1,584.89 | $2,344.23 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $354.81 / $645.65 / $1,698.24
| Professional | | $354.81 | $645.65 | $1,698.24 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $323.59 / $524.81 / $1,318.26
| Professional | | $323.59 | $524.81 | $1,318.26 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $812.83 / $2,041.74 / $3,235.94
| Professional | | $812.83 | $2,041.74 | $3,235.94 |