- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,037.60 / $4,104.45 / $8,074.63
| Facility | | $2,037.60 | $4,104.45 | $8,074.63 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,915.67 / $2,257.57 / $3,587.93
| Professional | | $1,915.67 | $2,257.57 | $3,587.93 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,329.50 / $16,401.00 / $29,216.95
| Facility | | $8,329.50 | $16,401.00 | $29,216.95 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,132.44 / $2,727.22 / $4,356.43
| Professional | | $2,132.44 | $2,727.22 | $4,356.43 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,490.65 / $2,490.65 / $3,479.22
| Facility | | $2,490.65 | $2,490.65 | $3,479.22 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,197.39 / $3,215.37 / $5,451.56
| Professional | | $2,197.39 | $3,215.37 | $5,451.56 |
- 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
- $2,134.86 / $2,935.32 / $5,227.09
| Professional | | $2,134.86 | $2,935.32 | $5,227.09 |