- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,951.21 / $5,370.32 / $9,549.93
| Facility | | $2,951.21 | $5,370.32 | $9,549.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,041.74 / $2,691.53 / $4,265.80
| Professional | | $2,041.74 | $2,691.53 | $4,265.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,238.72 / $6,025.60 / $12,302.69
| Facility | | $2,238.72 | $6,025.60 | $12,302.69 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,187.76 / $3,715.35 / $5,754.40
| Professional | | $2,187.76 | $3,715.35 | $5,754.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $501.19 / $2,511.89 / $4,168.69
| Facility | | $501.19 | $2,511.89 | $4,168.69 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,398.83 / $3,630.78 / $6,309.57
| Professional | | $2,398.83 | $3,630.78 | $6,309.57 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,691.53 / $3,548.13 / $13,182.57
| Professional | | $2,691.53 | $3,548.13 | $13,182.57 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4,466.84 / $4,466.84 / $4,466.84
| Professional | | $4,466.84 | $4,466.84 | $4,466.84 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $630.96 / $3,235.94 / $7,943.28
| Facility | | $630.96 | $3,235.94 | $7,943.28 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,995.26 / $2,951.21 / $5,495.41
| Professional | | $1,995.26 | $2,951.21 | $5,495.41 |