- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,258.23 / $4,256.44 / $8,074.63
| Facility | | $2,258.23 | $4,256.44 | $8,074.63 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,128.52 / $2,544.94 / $3,535.06
| Professional | | $2,128.52 | $2,544.94 | $3,535.06 |
- 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
- $2,135.73 / $2,872.78 / $4,635.82
| Professional | | $2,135.73 | $2,872.78 | $4,635.82 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,478.79 / $2,478.79 / $5,299.66
| Facility | | $2,478.79 | $2,478.79 | $5,299.66 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,403.61 / $3,276.60 / $5,382.82
| Professional | | $2,403.61 | $3,276.60 | $5,382.82 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,403.00 / $3,325.00 / $8,152.00
| Facility | | $1,403.00 | $3,325.00 | $8,152.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,206.54 / $3,140.49 / $5,364.77
| Professional | | $2,206.54 | $3,140.49 | $5,364.77 |