- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,553.59 / $9,813.00 / $14,552.94
| Facility | | $2,553.59 | $9,813.00 | $14,552.94 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $929.77 / $4,117.25 / $4,508.89
| Professional | | $929.77 | $4,117.25 | $4,508.89 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,931.31 / $2,931.31 / $2,931.31
| Professional | | $2,931.31 | $2,931.31 | $2,931.31 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,067.25 / $4,117.25 / $5,887.67
| Facility | | $1,067.25 | $4,117.25 | $5,887.67 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,095.25 / $5,441.10 / $7,035.41
| Professional | | $2,095.25 | $5,441.10 | $7,035.41 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,238.75 / $3,756.95 / $5,271.20
| Professional | | $3,238.75 | $3,756.95 | $5,271.20 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,067.25 / $4,117.25 / $5,887.67
| Facility | | $1,067.25 | $4,117.25 | $5,887.67 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,146.65 / $3,745.50 / $5,383.22
| Professional | | $1,146.65 | $3,745.50 | $5,383.22 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,226.17 / $2,345.04 / $5,252.92
| Professional | | $2,226.17 | $2,345.04 | $5,252.92 |