- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,344.23 / $4,265.80 / $4,897.79
| Facility | | $2,344.23 | $4,265.80 | $4,897.79 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,570.40 / $2,951.21 / $4,265.80
| Professional | | $2,570.40 | $2,951.21 | $4,265.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9,549.93 / $18,620.87 / $26,302.68
| Facility | | $9,549.93 | $18,620.87 | $26,302.68 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,344.23 / $2,951.21 / $4,897.79
| Professional | | $2,344.23 | $2,951.21 | $4,897.79 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,818.38 / $2,951.21 / $3,311.31
| Facility | | $2,818.38 | $2,951.21 | $3,311.31 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,630.27 / $3,311.31 / $5,888.44
| Professional | | $2,630.27 | $3,311.31 | $5,888.44 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,412.54 / $5,754.40 / $12,022.64
| Facility | | $1,412.54 | $5,754.40 | $12,022.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,344.23 / $3,162.28 / $5,011.87
| Professional | | $2,344.23 | $3,162.28 | $5,011.87 |