- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,402.73 / $5,982.00 / $11,298.00
| Facility | | $2,402.73 | $5,982.00 | $11,298.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,402.73 / $2,954.63 / $5,174.31
| Professional | | $2,402.73 | $2,954.63 | $5,174.31 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,009.17 / $4,446.49 / $9,477.67
| Professional | | $2,009.17 | $4,446.49 | $9,477.67 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,362.03 / $4,561.67 / $5,405.44
| Professional | | $3,362.03 | $4,561.67 | $5,405.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,390.69 / $3,125.31 / $5,416.22
| Professional | | $2,390.69 | $3,125.31 | $5,416.22 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,846.00 / $7,273.00 / $10,536.00
| Facility | | $1,846.00 | $7,273.00 | $10,536.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,192.87 / $3,145.98 / $6,100.57
| Professional | | $2,192.87 | $3,145.98 | $6,100.57 |