- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,048.95 / $4,052.02 / $8,074.63
| Facility | | $2,048.95 | $4,052.02 | $8,074.63 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,905.48 / $2,288.06 / $3,329.06
| Professional | | $1,905.48 | $2,288.06 | $3,329.06 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,299.00 / $10,800.00 / $22,259.10
| Facility | | $5,299.00 | $10,800.00 | $22,259.10 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,006.19 / $2,451.01 / $3,889.54
| Professional | | $2,006.19 | $2,451.01 | $3,889.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,284.13 / $2,284.13 / $3,216.32
| Facility | | $2,284.13 | $2,284.13 | $3,216.32 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,009.38 / $2,893.62 / $4,871.78
| Professional | | $2,009.38 | $2,893.62 | $4,871.78 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,403.00 / $3,325.00 / $8,198.00
| Facility | | $1,403.00 | $3,325.00 | $8,198.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,947.83 / $2,669.42 / $4,603.62
| Professional | | $1,947.83 | $2,669.42 | $4,603.62 |