- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,730.61 / $6,607.00 / $10,492.00
| Facility | | $1,730.61 | $6,607.00 | $10,492.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,452.61 / $1,730.61 / $2,823.26
| Professional | | $1,452.61 | $1,730.61 | $2,823.26 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,021.45 / $11,830.00 / $17,740.11
| Facility | | $4,021.45 | $11,830.00 | $17,740.11 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,088.67 / $2,278.23 / $2,756.89
| Professional | | $1,088.67 | $2,278.23 | $2,756.89 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,365.12 / $1,711.87 / $3,452.22
| Professional | | $1,365.12 | $1,711.87 | $3,452.22 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,519.68 / $1,803.47 / $1,803.47
| Professional | | $1,519.68 | $1,803.47 | $1,803.47 |
- 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
- $1,142.96 / $1,671.43 / $3,298.47
| Professional | | $1,142.96 | $1,671.43 | $3,298.47 |