- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,587.09 / $6,607.00 / $10,492.00
| Facility | | $3,587.09 | $6,607.00 | $10,492.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,016.48 / $3,587.09 / $5,802.48
| Professional | | $2,016.48 | $3,587.09 | $5,802.48 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12,098.00 / $12,905.00 / $17,206.00
| Facility | | $12,098.00 | $12,905.00 | $17,206.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,104.09 / $4,738.08 / $5,370.34
| Professional | | $2,104.09 | $4,738.08 | $5,370.34 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,947.91 / $2,656.99 / $5,768.71
| Professional | | $1,947.91 | $2,656.99 | $5,768.71 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,946.31 / $2,946.31 / $3,583.16
| Professional | | $2,946.31 | $2,946.31 | $3,583.16 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,275.00 / $5,345.00 / $14,963.00
| Facility | | $3,275.00 | $5,345.00 | $14,963.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,154.88 / $3,491.27 / $6,879.94
| Professional | | $2,154.88 | $3,491.27 | $6,879.94 |