- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,162.28 / $5,888.44 / $10,471.29
| Facility | | $3,162.28 | $5,888.44 | $10,471.29 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,398.83 / $2,818.38 / $4,466.84
| Professional | | $2,398.83 | $2,818.38 | $4,466.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,630.78 / $3,630.78 / $3,630.78
| Professional | | $3,630.78 | $3,630.78 | $3,630.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,570.40 / $3,467.37 / $5,623.41
| Professional | | $2,570.40 | $3,467.37 | $5,623.41 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $54.95 / $3,090.30 / $4,897.79
| Facility | | $54.95 | $3,090.30 | $4,897.79 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,630.27 / $3,162.28 / $19,952.62
| Professional | | $2,630.27 | $3,162.28 | $19,952.62 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $851.14 / $1,445.44 / $5,623.41
| Facility | | $851.14 | $1,445.44 | $5,623.41 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,570.40 / $3,090.30 / $4,677.35
| Professional | | $2,570.40 | $3,090.30 | $4,677.35 |