- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,077.32 / $3,159.42 / $7,210.11
| Facility | | $2,077.32 | $3,159.42 | $7,210.11 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,674.49 / $2,077.32 / $2,211.59
| Professional | | $1,674.49 | $2,077.32 | $2,211.59 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $540.79 / $4,636.45 / $7,819.56
| Facility | | $540.79 | $4,636.45 | $7,819.56 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $479.80 / $632.33 / $2,085.21
| Professional | | $479.80 | $632.33 | $2,085.21 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,053.62 / $8,760.49 / $18,134.18
| Facility | | $2,053.62 | $8,760.49 | $18,134.18 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,633.33 / $5,756.46 / $42,499.58
| Professional | | $3,633.33 | $5,756.46 | $42,499.58 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,579.71 / $1,895.65 / $5,544.47
| Professional | | $1,579.71 | $1,895.65 | $5,544.47 |