- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,949.46 / $9,813.00 / $14,552.94
| Facility | | $2,949.46 | $9,813.00 | $14,552.94 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $937.19 / $5,002.37 / $5,002.37
| Professional | | $937.19 | $5,002.37 | $5,002.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,521.71 / $3,393.43 / $4,358.22
| Professional | | $2,521.71 | $3,393.43 | $4,358.22 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $948.90 / $5,002.37 / $7,003.32
| Facility | | $948.90 | $5,002.37 | $7,003.32 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,466.42 / $2,959.71 / $6,008.50
| Professional | | $2,466.42 | $2,959.71 | $6,008.50 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,740.00 / $5,022.39 / $6,050.00
| Professional | | $3,740.00 | $5,022.39 | $6,050.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $948.90 / $5,002.37 / $7,003.32
| Facility | | $948.90 | $5,002.37 | $7,003.32 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,520.90 / $4,964.00 / $6,580.20
| Professional | | $1,520.90 | $4,964.00 | $6,580.20 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,714.74 / $4,652.87 / $5,972.43
| Professional | | $2,714.74 | $4,652.87 | $5,972.43 |