- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,529.08 / $5,708.80 / $15,453.30
| Facility | | $3,529.08 | $5,708.80 | $15,453.30 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,594.91 / $2,904.75 / $3,292.05
| Professional | | $2,594.91 | $2,904.75 | $3,292.05 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,009.92 / $7,633.07 / $12,091.85
| Facility | | $2,009.92 | $7,633.07 | $12,091.85 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,541.27 / $3,696.39 / $17,904.40
| Professional | | $2,541.27 | $3,696.39 | $17,904.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,587.12 / $6,293.63 / $11,328.53
| Facility | | $2,587.12 | $6,293.63 | $11,328.53 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $46.16 / $2,051.32 / $5,374.34
| Professional | | $46.16 | $2,051.32 | $5,374.34 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,594.91 / $3,873.00 / $7,129.99
| Facility | | $2,594.91 | $3,873.00 | $7,129.99 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,626.66 / $1,626.66 / $19,287.54
| Professional | | $1,626.66 | $1,626.66 | $19,287.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,626.66 / $1,626.66 / $2,323.80
| Professional | | $1,626.66 | $1,626.66 | $2,323.80 |