- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,737.80 / $4,677.35 / $11,220.18
| Facility | | $1,737.80 | $4,677.35 | $11,220.18 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,621.81 / $1,905.46 / $3,981.07
| Professional | | $1,621.81 | $1,905.46 | $3,981.07 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,981.07 / $11,220.18 / $22,908.68
| Facility | | $3,981.07 | $11,220.18 | $22,908.68 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,698.24 / $2,691.53 / $4,786.30
| Professional | | $1,698.24 | $2,691.53 | $4,786.30 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $398.11 / $3,801.89 / $12,882.50
| Facility | | $398.11 | $3,801.89 | $12,882.50 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,819.70 / $2,884.03 / $5,754.40
| Professional | | $1,819.70 | $2,884.03 | $5,754.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,630.27 / $8,128.31 / $17,782.79
| Facility | | $2,630.27 | $8,128.31 | $17,782.79 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,548.82 / $2,290.87 / $4,073.80
| Professional | | $1,548.82 | $2,290.87 | $4,073.80 |