- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,819.70 / $3,890.45 / $8,912.51
| Facility | | $1,819.70 | $3,890.45 | $8,912.51 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,096.48 / $3,235.94 / $6,918.31
| Professional | | $1,096.48 | $3,235.94 | $6,918.31 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,888.44 / $6,760.83 / $7,413.10
| Facility | | $5,888.44 | $6,760.83 | $7,413.10 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $169.82 / $213.80 / $302.00
| Professional | | $169.82 | $213.80 | $302.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,089.30 / $5,248.07 / $10,964.78
| Facility | | $2,089.30 | $5,248.07 | $10,964.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,089.30 / $5,248.07 / $10,964.78
| Professional | | $2,089.30 | $5,248.07 | $10,964.78 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,606.93 / $12,882.50 / $29,512.09
| Facility | | $6,606.93 | $12,882.50 | $29,512.09 |