- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,892.16 / $3,832.83 / $8,074.63
| Facility | | $1,892.16 | $3,832.83 | $8,074.63 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,792.80 / $2,086.80 / $3,419.38
| Professional | | $1,792.80 | $2,086.80 | $3,419.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,105.25 / $16,184.00 / $28,850.83
| Facility | | $8,105.25 | $16,184.00 | $28,850.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,985.26 / $2,578.60 / $4,022.26
| Professional | | $1,985.26 | $2,578.60 | $4,022.26 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,297.96 / $2,297.96 / $3,212.11
| Facility | | $2,297.96 | $2,297.96 | $3,212.11 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,041.03 / $2,984.34 / $4,601.81
| Professional | | $2,041.03 | $2,984.34 | $4,601.81 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,403.00 / $3,325.00 / $8,198.00
| Facility | | $1,403.00 | $3,325.00 | $8,198.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,956.80 / $2,712.08 / $4,995.02
| Professional | | $1,956.80 | $2,712.08 | $4,995.02 |