- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,750.41 / $3,973.97 / $9,546.32
| Facility | | $2,750.41 | $3,973.97 | $9,546.32 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,217.06 / $2,750.41 / $2,928.20
| Professional | | $2,217.06 | $2,750.41 | $2,928.20 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $224.97 / $6,138.74 / $10,353.25
| Facility | | $224.97 | $6,138.74 | $10,353.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,882.40 / $3,116.43 / $9,505.86
| Professional | | $1,882.40 | $3,116.43 | $9,505.86 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,719.03 / $11,598.63 / $24,009.16
| Facility | | $2,719.03 | $11,598.63 | $24,009.16 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,709.62 / $6,577.97 / $10,332.33
| Professional | | $3,709.62 | $6,577.97 | $10,332.33 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,924.24 / $2,509.88 / $7,340.97
| Professional | | $1,924.24 | $2,509.88 | $7,340.97 |