- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,875.44 / $3,801.52 / $10,871.90
| Facility | | $1,875.44 | $3,801.52 | $10,871.90 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $320.58 / $2,087.71 / $2,804.40
| Professional | | $320.58 | $2,087.71 | $2,804.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,764.98 / $2,470.96 / $11,715.92
| Facility | | $1,764.98 | $2,470.96 | $11,715.92 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,556.41 / $3,144.54 / $5,322.46
| Professional | | $1,556.41 | $3,144.54 | $5,322.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,869.60 / $1,869.60 / $2,732.13
| Professional | | $1,869.60 | $1,869.60 | $2,732.13 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,125.73 / $3,125.73 / $5,001.16
| Professional | | $3,125.73 | $3,125.73 | $5,001.16 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,674.00 / $4,674.00 / $4,674.00
| Facility | | $4,674.00 | $4,674.00 | $4,674.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,090.59 / $1,312.81 / $4,882.34
| Professional | | $1,090.59 | $1,312.81 | $4,882.34 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,869.60 / $1,869.60 / $1,869.60
| Professional | | $1,869.60 | $1,869.60 | $1,869.60 |