- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,137.96 / $5,128.61 / $7,762.47
| Facility | | $2,137.96 | $5,128.61 | $7,762.47 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,862.09 / $2,754.23 / $7,413.10
| Professional | | $1,862.09 | $2,754.23 | $7,413.10 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $537.03 / $2,754.23 / $5,495.41
| Professional | | $537.03 | $2,754.23 | $5,495.41 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,630.27 / $3,981.07 / $7,413.10
| Professional | | $2,630.27 | $3,981.07 | $7,413.10 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,570.40 / $5,495.41 / $6,025.60
| Professional | | $2,570.40 | $5,495.41 | $6,025.60 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,073.80 / $16,218.10 / $35,481.34
| Facility | | $4,073.80 | $16,218.10 | $35,481.34 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,187.76 / $3,548.13 / $7,413.10
| Professional | | $2,187.76 | $3,548.13 | $7,413.10 |