- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,388.44 / $4,677.35 / $7,079.46
| Facility | | $3,388.44 | $4,677.35 | $7,079.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,235.94 / $4,466.84 / $6,025.60
| Professional | | $3,235.94 | $4,466.84 | $6,025.60 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $436.52 / $436.52 / $14,454.40
| Facility | | $436.52 | $436.52 | $14,454.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4,073.80 / $5,754.40 / $7,943.28
| Professional | | $4,073.80 | $5,754.40 | $7,943.28 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,786.30 / $4,786.30 / $7,762.47
| Facility | | $4,786.30 | $4,786.30 | $7,762.47 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,311.31 / $4,786.30 / $11,220.18
| Professional | | $3,311.31 | $4,786.30 | $11,220.18 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $346.74 / $2,884.03 / $5,623.41
| Facility | | $346.74 | $2,884.03 | $5,623.41 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,630.27 / $3,890.45 / $6,456.54
| Professional | | $2,630.27 | $3,890.45 | $6,456.54 |