- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,052.69 / $5,131.72 / $22,153.60
| Facility | | $2,052.69 | $5,131.72 | $22,153.60 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,052.69 / $3,020.94 / $3,679.35
| Professional | | $2,052.69 | $3,020.94 | $3,679.35 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,785.86 / $8,536.74 / $17,747.43
| Facility | | $3,785.86 | $8,536.74 | $17,747.43 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,182.23 / $4,005.96 / $8,173.12
| Professional | | $2,182.23 | $4,005.96 | $8,173.12 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,711.10 / $4,066.65 / $5,615.85
| Professional | | $2,711.10 | $4,066.65 | $5,615.85 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,873.00 / $13,785.00 / $13,785.00
| Facility | | $3,873.00 | $13,785.00 | $13,785.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,130.15 / $3,485.70 / $4,647.60
| Facility | | $2,130.15 | $3,485.70 | $4,647.60 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,549.20 / $2,323.80 / $3,969.83
| Professional | | $1,549.20 | $2,323.80 | $3,969.83 |