- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,616.17 / $5,695.00 / $10,871.00
| Facility | | $2,616.17 | $5,695.00 | $10,871.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,159.51 / $2,645.72 / $4,315.35
| Professional | | $2,159.51 | $2,645.72 | $4,315.35 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $16,700.16 / $19,158.88 / $21,611.98
| Facility | | $16,700.16 | $19,158.88 | $21,611.98 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,581.48 / $3,972.94 / $9,511.93
| Professional | | $2,581.48 | $3,972.94 | $9,511.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,151.91 / $4,093.76 / $4,459.32
| Professional | | $3,151.91 | $4,093.76 | $4,459.32 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,313.37 / $3,149.17 / $6,619.07
| Professional | | $2,313.37 | $3,149.17 | $6,619.07 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,846.00 / $7,273.00 / $10,536.00
| Facility | | $1,846.00 | $7,273.00 | $10,536.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,090.28 / $3,456.03 / $6,633.05
| Professional | | $2,090.28 | $3,456.03 | $6,633.05 |