- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,732.34 / $4,325.50 / $9,841.00
| Facility | | $1,732.34 | $4,325.50 | $9,841.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,468.84 / $1,688.69 / $2,682.42
| Professional | | $1,468.84 | $1,688.69 | $2,682.42 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,977.00 / $10,576.00 / $21,862.00
| Facility | | $4,977.00 | $10,576.00 | $21,862.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,539.12 / $2,059.65 / $3,808.50
| Professional | | $1,539.12 | $2,059.65 | $3,808.50 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,877.47 / $2,862.32 / $14,645.39
| Facility | | $1,877.47 | $2,862.32 | $14,645.39 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,641.33 / $2,367.99 / $3,633.54
| Professional | | $1,641.33 | $2,367.99 | $3,633.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,380.50 / $7,183.50 / $15,907.66
| Facility | | $3,380.50 | $7,183.50 | $15,907.66 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,477.31 / $2,055.03 / $3,680.84
| Professional | | $1,477.31 | $2,055.03 | $3,680.84 |