- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,040.08 / $2,098.61 / $12,774.20
| Facility | | $1,040.08 | $2,098.61 | $12,774.20 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,423.41 / $1,740.10 / $2,013.55
| Professional | | $1,423.41 | $1,740.10 | $2,013.55 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,001.93 / $3,532.60 / $9,086.62
| Facility | | $3,001.93 | $3,532.60 | $9,086.62 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $729.95 / $1,186.17 / $1,186.17
| Professional | | $729.95 | $1,186.17 | $1,186.17 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,375.84 / $6,896.39 / $9,432.46
| Facility | | $3,375.84 | $6,896.39 | $9,432.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $945.26 / $3,565.33 / $7,582.59
| Professional | | $945.26 | $3,565.33 | $7,582.59 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,824.88 / $2,648.63 / $6,492.74
| Professional | | $1,824.88 | $2,648.63 | $6,492.74 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $766.45 / $1,094.93 / $1,491.52
| Professional | | $766.45 | $1,094.93 | $1,491.52 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,664.60 / $2,247.21 / $3,218.63
| Professional | | $1,664.60 | $2,247.21 | $3,218.63 |