- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,479.11 / $2,137.96 / $3,630.78
| Facility | | $1,479.11 | $2,137.96 | $3,630.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $389.05 / $467.74 / $2,570.40
| Professional | | $389.05 | $467.74 | $2,570.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,000.00 / $1,122.02 / $3,311.31
| Facility | | $1,000.00 | $1,122.02 | $3,311.31 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $288.40 / $380.19 / $1,096.48
| Professional | | $288.40 | $380.19 | $1,096.48 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $933.25 / $2,187.76 / $3,548.13
| Facility | | $933.25 | $2,187.76 | $3,548.13 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $302.00 / $446.68 / $831.76
| Professional | | $302.00 | $446.68 | $831.76 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $575.44 / $1,000.00 / $1,862.09
| Professional | | $575.44 | $1,000.00 | $1,862.09 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $245.47 / $346.74 / $1,698.24
| Professional | | $245.47 | $346.74 | $1,698.24 |