- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,288.25 / $2,630.27 / $6,606.93
| Facility | | $1,288.25 | $2,630.27 | $6,606.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,398.83 / $2,691.53 / $5,623.41
| Professional | | $2,398.83 | $2,691.53 | $5,623.41 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,884.03 / $3,630.78 / $3,981.07
| Professional | | $2,884.03 | $3,630.78 | $3,981.07 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,818.38 / $3,548.13 / $4,570.88
| Professional | | $2,818.38 | $3,548.13 | $4,570.88 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $489.78 / $2,630.27 / $7,244.36
| Facility | | $489.78 | $2,630.27 | $7,244.36 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,454.71 / $3,090.30 / $21,379.62
| Professional | | $2,454.71 | $3,090.30 | $21,379.62 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $346.74 / $1,949.84 / $6,165.95
| Facility | | $346.74 | $1,949.84 | $6,165.95 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,238.72 / $2,818.38 / $3,981.07
| Professional | | $2,238.72 | $2,818.38 | $3,981.07 |