- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,344.23 / $4,365.16 / $7,413.10
| Facility | | $2,344.23 | $4,365.16 | $7,413.10 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,570.40 / $3,388.44 / $4,073.80
| Professional | | $2,570.40 | $3,388.44 | $4,073.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,071.52 / $3,019.95 / $6,918.31
| Facility | | $1,071.52 | $3,019.95 | $6,918.31 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,691.53 / $3,548.13 / $3,801.89
| Professional | | $2,691.53 | $3,548.13 | $3,801.89 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $891.25 / $891.25 / $891.25
| Facility | | $891.25 | $891.25 | $891.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,818.38 / $3,388.44 / $4,786.30
| Professional | | $2,818.38 | $3,388.44 | $4,786.30 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $602.56 / $3,090.30 / $5,370.32
| Facility | | $602.56 | $3,090.30 | $5,370.32 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,311.31 / $5,128.61 / $7,762.47
| Professional | | $3,311.31 | $5,128.61 | $7,762.47 |