- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,180.52 / $6,907.47 / $19,485.87
| Facility | | $3,180.52 | $6,907.47 | $19,485.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,237.56 / $1,335.97 / $1,540.89
| Professional | | $1,237.56 | $1,335.97 | $1,540.89 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,248.00 / $1,248.00 / $1,248.00
| Facility | | $1,248.00 | $1,248.00 | $1,248.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,066.97 / $1,314.43 / $2,081.03
| Professional | | $1,066.97 | $1,314.43 | $2,081.03 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,555.33 / $8,555.33 / $9,395.79
| Facility | | $8,555.33 | $8,555.33 | $9,395.79 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,222.28 / $1,222.28 / $1,222.28
| Professional | | $1,222.28 | $1,222.28 | $1,222.28 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,004.40 / $1,272.04 / $2,679.61
| Professional | | $1,004.40 | $1,272.04 | $2,679.61 |