- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,028.48 / $9,774.00 / $14,552.94
| Facility | | $3,028.48 | $9,774.00 | $14,552.94 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5,109.71 / $5,109.71 / $5,352.85
| Professional | | $5,109.71 | $5,109.71 | $5,352.85 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,728.72 / $1,728.72 / $3,349.38
| Professional | | $1,728.72 | $1,728.72 | $3,349.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,109.71 / $7,153.59 / $7,306.89
| Facility | | $5,109.71 | $7,153.59 | $7,306.89 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,347.13 / $2,795.70 / $3,129.51
| Professional | | $2,347.13 | $2,795.70 | $3,129.51 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,309.09 / $4,311.89 / $4,676.25
| Professional | | $2,309.09 | $4,311.89 | $4,676.25 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,109.71 / $7,153.59 / $7,306.89
| Facility | | $5,109.71 | $7,153.59 | $7,306.89 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,371.33 / $3,220.19 / $6,562.52
| Professional | | $1,371.33 | $3,220.19 | $6,562.52 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,167.83 / $2,679.50 / $4,042.31
| Professional | | $1,167.83 | $2,679.50 | $4,042.31 |