- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,007.11 / $2,517.77 / $10,869.10
| Facility | | $1,007.11 | $2,517.77 | $10,869.10 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,007.11 / $1,482.16 / $1,615.17
| Professional | | $1,007.11 | $1,482.16 | $1,615.17 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,857.45 / $2,403.75 / $6,409.29
| Facility | | $1,857.45 | $2,403.75 | $6,409.29 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,330.14 / $2,489.26 / $3,462.16
| Professional | | $1,330.14 | $2,489.26 | $3,462.16 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,330.14 / $1,330.14 / $8,702.00
| Facility | | $1,330.14 | $1,330.14 | $8,702.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,330.14 / $1,330.14 / $1,330.14
| Professional | | $1,330.14 | $1,330.14 | $1,330.14 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $798.08 / $1,140.11 / $1,938.20
| Professional | | $798.08 | $1,140.11 | $1,938.20 |