- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,949.84 / $2,089.30 / $8,511.38
| Facility | | $1,949.84 | $2,089.30 | $8,511.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,905.46 / $2,344.23 / $4,365.16
| Professional | | $1,905.46 | $2,344.23 | $4,365.16 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,801.89 / $4,786.30 / $5,623.41
| Professional | | $3,801.89 | $4,786.30 | $5,623.41 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,187.76 / $3,890.45 / $6,025.60
| Professional | | $2,187.76 | $3,890.45 | $6,025.60 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,089.30 / $2,951.21 / $4,466.84
| Facility | | $2,089.30 | $2,951.21 | $4,466.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,905.46 / $3,235.94 / $15,848.93
| Professional | | $1,905.46 | $3,235.94 | $15,848.93 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $676.08 / $1,819.70 / $2,041.74
| Facility | | $676.08 | $1,819.70 | $2,041.74 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,905.46 / $2,884.03 / $4,677.35
| Professional | | $1,905.46 | $2,884.03 | $4,677.35 |