- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,997.32 / $5,932.63 / $9,167.10
| Facility | | $2,997.32 | $5,932.63 | $9,167.10 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,153.25 / $2,497.77 / $3,071.97
| Professional | | $2,153.25 | $2,497.77 | $3,071.97 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,588.75 / $3,588.75 / $3,588.75
| Professional | | $3,588.75 | $3,588.75 | $3,588.75 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,334.55 / $5,404.37 / $8,862.54
| Facility | | $2,334.55 | $5,404.37 | $8,862.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,546.80 / $2,741.81 / $4,163.00
| Professional | | $2,546.80 | $2,741.81 | $4,163.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,842.79 / $2,871.00 / $3,862.39
| Facility | | $1,842.79 | $2,871.00 | $3,862.39 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,205.82 / $1,722.60 / $14,355.00
| Professional | | $1,205.82 | $1,722.60 | $14,355.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,205.82 / $1,722.60 / $4,306.50
| Professional | | $1,205.82 | $1,722.60 | $4,306.50 |