- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,017.47 / $6,607.00 / $10,492.00
| Facility | | $2,017.47 | $6,607.00 | $10,492.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,739.37 / $2,017.47 / $3,386.82
| Professional | | $1,739.37 | $2,017.47 | $3,386.82 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,927.44 / $14,057.22 / $19,128.36
| Facility | | $5,927.44 | $14,057.22 | $19,128.36 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,296.78 / $2,712.33 / $3,307.26
| Professional | | $1,296.78 | $2,712.33 | $3,307.26 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,632.97 / $2,058.05 / $4,134.09
| Professional | | $1,632.97 | $2,058.05 | $4,134.09 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,817.61 / $2,148.09 / $2,148.09
| Professional | | $1,817.61 | $2,148.09 | $2,148.09 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,275.00 / $6,137.00 / $16,193.00
| Facility | | $3,275.00 | $6,137.00 | $16,193.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,300.66 / $2,278.91 / $3,940.28
| Professional | | $1,300.66 | $2,278.91 | $3,940.28 |