- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,236.00 / $9,577.00 / $14,552.94
| Facility | | $2,236.00 | $9,577.00 | $14,552.94 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $584.38 / $3,041.28 / $3,041.28
| Professional | | $584.38 | $3,041.28 | $3,041.28 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,527.39 / $2,034.10 / $2,711.96
| Professional | | $1,527.39 | $2,034.10 | $2,711.96 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $598.87 / $3,041.28 / $4,257.79
| Facility | | $598.87 | $3,041.28 | $4,257.79 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,563.15 / $1,875.78 / $3,808.01
| Professional | | $1,563.15 | $1,875.78 | $3,808.01 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,223.75 / $3,101.16 / $3,828.00
| Professional | | $2,223.75 | $3,101.16 | $3,828.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $598.87 / $3,041.28 / $4,257.79
| Facility | | $598.87 | $3,041.28 | $4,257.79 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $930.71 / $3,065.10 / $3,953.40
| Professional | | $930.71 | $3,065.10 | $3,953.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,627.28 / $2,847.74 / $3,580.02
| Professional | | $1,627.28 | $2,847.74 | $3,580.02 |