- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,344.23 / $4,073.80 / $7,079.46
| Facility | | $2,344.23 | $4,073.80 | $7,079.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,344.23 / $3,890.45 / $15,488.17
| Professional | | $2,344.23 | $3,890.45 | $15,488.17 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,905.46 / $3,630.78 / $6,309.57
| Facility | | $1,905.46 | $3,630.78 | $6,309.57 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,047.13 / $2,290.87 / $3,090.30
| Professional | | $1,047.13 | $2,290.87 | $3,090.30 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,513.56 / $3,162.28 / $8,511.38
| Facility | | $1,513.56 | $3,162.28 | $8,511.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,548.82 / $2,884.03 / $5,248.07
| Professional | | $1,548.82 | $2,884.03 | $5,248.07 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,290.87 / $3,090.30 / $4,466.84
| Professional | | $2,290.87 | $3,090.30 | $4,466.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,122.02 / $1,412.54 / $4,073.80
| Professional | | $1,122.02 | $1,412.54 | $4,073.80 |