- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,691.53 / $6,760.83 / $9,772.37
| Facility | | $2,691.53 | $6,760.83 | $9,772.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,344.23 / $2,691.53 / $2,884.03
| Professional | | $2,344.23 | $2,691.53 | $2,884.03 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5,011.87 / $6,760.83 / $8,511.38
| Professional | | $5,011.87 | $6,760.83 | $8,511.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $151.36 / $4,365.16 / $6,309.57
| Professional | | $151.36 | $4,365.16 | $6,309.57 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,548.13 / $4,265.80 / $9,332.54
| Facility | | $3,548.13 | $4,265.80 | $9,332.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,089.30 / $2,089.30 / $8,128.31
| Professional | | $2,089.30 | $2,089.30 | $8,128.31 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4,265.80 / $4,265.80 / $4,265.80
| Professional | | $4,265.80 | $4,265.80 | $4,265.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,548.13 / $3,548.13 / $7,762.47
| Facility | | $3,548.13 | $3,548.13 | $7,762.47 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,089.30 / $2,089.30 / $7,585.78
| Professional | | $2,089.30 | $2,089.30 | $7,585.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,754.23 / $3,548.13 / $3,548.13
| Professional | | $2,754.23 | $3,548.13 | $3,548.13 |