- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,288.25 / $3,890.45 / $6,606.93
| Facility | | $1,288.25 | $3,890.45 | $6,606.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,467.37 / $3,981.07 / $6,456.54
| Professional | | $3,467.37 | $3,981.07 | $6,456.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,995.26 / $4,570.88 / $6,456.54
| Professional | | $1,995.26 | $4,570.88 | $6,456.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,096.48 / $4,073.80 / $6,606.93
| Facility | | $1,096.48 | $4,073.80 | $6,606.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,162.28 / $4,365.16 / $26,915.35
| Professional | | $3,162.28 | $4,365.16 | $26,915.35 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $346.74 / $1,949.84 / $6,165.95
| Facility | | $346.74 | $1,949.84 | $6,165.95 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,090.30 / $3,981.07 / $5,888.44
| Professional | | $3,090.30 | $3,981.07 | $5,888.44 |