- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9,772.37 / $12,022.64 / $16,595.87
| Facility | | $9,772.37 | $12,022.64 | $16,595.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $380.19 / $549.54 / $6,309.57
| Professional | | $380.19 | $549.54 | $6,309.57 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $478.63 / $741.31 / $1,513.56
| Professional | | $478.63 | $741.31 | $1,513.56 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $478.63 / $691.83 / $6,309.57
| Facility | | $478.63 | $691.83 | $6,309.57 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $380.19 / $512.86 / $6,309.57
| Professional | | $380.19 | $512.86 | $6,309.57 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,096.48 / $2,041.74 / $2,754.23
| Professional | | $1,096.48 | $2,041.74 | $2,754.23 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $512.86 / $831.76 / $6,309.57
| Facility | | $512.86 | $831.76 | $6,309.57 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $60.26 / $630.96 / $1,513.56
| Professional | | $60.26 | $630.96 | $1,513.56 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $407.38 / $1,000.00 / $2,398.83
| Professional | | $407.38 | $1,000.00 | $2,398.83 |