- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $933.25 / $3,467.37 / $5,248.07
| Facility | | $933.25 | $3,467.37 | $5,248.07 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,162.28 / $3,801.89 / $6,760.83
| Professional | | $3,162.28 | $3,801.89 | $6,760.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4,073.80 / $4,897.79 / $6,025.60
| Professional | | $4,073.80 | $4,897.79 | $6,025.60 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $39.81 / $3,235.94 / $3,235.94
| Facility | | $39.81 | $3,235.94 | $3,235.94 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4,365.16 / $14,125.38 / $16,982.44
| Professional | | $4,365.16 | $14,125.38 | $16,982.44 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $371.54 / $1,174.90 / $5,754.40
| Facility | | $371.54 | $1,174.90 | $5,754.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,019.95 / $3,981.07 / $6,606.93
| Professional | | $3,019.95 | $3,981.07 | $6,606.93 |