- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,362.54 / $4,391.34 / $8,074.63
| Facility | | $2,362.54 | $4,391.34 | $8,074.63 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,271.17 / $2,746.65 / $3,767.60
| Professional | | $2,271.17 | $2,746.65 | $3,767.60 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,769.10 / $8,981.00 / $15,216.00
| Facility | | $4,769.10 | $8,981.00 | $15,216.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,275.57 / $3,061.75 / $4,932.82
| Professional | | $2,275.57 | $3,061.75 | $4,932.82 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,640.96 / $2,640.96 / $5,409.82
| Facility | | $2,640.96 | $2,640.96 | $5,409.82 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,561.87 / $3,492.81 / $5,784.33
| Professional | | $2,561.87 | $3,492.81 | $5,784.33 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,367.00 / $3,236.00 / $6,792.00
| Facility | | $1,367.00 | $3,236.00 | $6,792.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,366.89 / $3,360.30 / $5,715.66
| Professional | | $2,366.89 | $3,360.30 | $5,715.66 |