- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,002.07 / $1,133.00 / $3,647.53
| Facility | | $1,002.07 | $1,133.00 | $3,647.53 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,002.07 / $1,042.15 / $1,269.29
| Professional | | $1,002.07 | $1,042.15 | $1,269.29 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $694.77 / $1,763.64 / $2,632.10
| Professional | | $694.77 | $1,763.64 | $2,632.10 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $881.49 / $2,878.84 / $4,770.18
| Facility | | $881.49 | $2,878.84 | $4,770.18 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,336.09 / $1,336.09 / $6,439.95
| Professional | | $1,336.09 | $1,336.09 | $6,439.95 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,324.80 / $6,346.43 / $6,346.43
| Facility | | $2,324.80 | $6,346.43 | $6,346.43 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $6,653.73 / $6,653.73 / $10,020.68
| Professional | | $6,653.73 | $6,653.73 | $10,020.68 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $561.16 / $801.65 / $1,336.09
| Professional | | $561.16 | $801.65 | $1,336.09 |