- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $977.24 / $1,288.25 / $2,511.89
| Facility | | $977.24 | $1,288.25 | $2,511.89 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,023.29 / $1,288.25 / $2,187.76
| Professional | | $1,023.29 | $1,288.25 | $2,187.76 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,000.00 / $1,380.38 / $4,786.30
| Facility | | $1,000.00 | $1,380.38 | $4,786.30 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,288.25 / $1,318.26 / $2,951.21
| Professional | | $1,288.25 | $1,318.26 | $2,951.21 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,621.81 / $1,621.81 / $10,000.00
| Facility | | $1,621.81 | $1,621.81 | $10,000.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,174.90 / $1,174.90 / $3,548.13
| Professional | | $1,174.90 | $1,174.90 | $3,548.13 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $831.76 / $1,380.38 / $3,019.95
| Facility | | $831.76 | $1,380.38 | $3,019.95 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $851.14 / $1,202.26 / $1,905.46
| Professional | | $851.14 | $1,202.26 | $1,905.46 |