- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,311.31 / $7,244.36 / $19,952.62
| Facility | | $3,311.31 | $7,244.36 | $19,952.62 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,000.00 / $3,801.89 / $6,165.95
| Professional | | $1,000.00 | $3,801.89 | $6,165.95 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,981.07 / $6,165.95 / $20,892.96
| Facility | | $3,981.07 | $6,165.95 | $20,892.96 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $794.33 / $1,905.46 / $6,025.60
| Professional | | $794.33 | $1,905.46 | $6,025.60 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,090.30 / $8,511.38 / $19,498.45
| Facility | | $3,090.30 | $8,511.38 | $19,498.45 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,398.83 / $5,754.40 / $11,481.54
| Professional | | $2,398.83 | $5,754.40 | $11,481.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,137.96 / $4,786.30 / $5,754.40
| Facility | | $2,137.96 | $4,786.30 | $5,754.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,995.26 / $2,884.03 / $5,495.41
| Professional | | $1,995.26 | $2,884.03 | $5,495.41 |