- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $153.00 / $4,560.89 / $7,890.36
| Facility | | $153.00 | $4,560.89 | $7,890.36 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,807.15 / $6,266.39 / $6,893.03
| Professional | | $2,807.15 | $6,266.39 | $6,893.03 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,062.00 / $1,505.00 / $4,720.00
| Facility | | $1,062.00 | $1,505.00 | $4,720.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,151.51 / $4,758.58 / $7,633.32
| Professional | | $3,151.51 | $4,758.58 | $7,633.32 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,821.49 / $2,821.49 / $2,821.49
| Professional | | $2,821.49 | $2,821.49 | $2,821.49 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,492.63 / $4,560.89 / $7,662.31
| Facility | | $2,492.63 | $4,560.89 | $7,662.31 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,984.25 / $4,490.58 / $5,627.44
| Professional | | $2,984.25 | $4,490.58 | $5,627.44 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9,251.00 / $11,924.00 / $19,737.00
| Facility | | $9,251.00 | $11,924.00 | $19,737.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,636.01 / $4,718.16 / $7,465.45
| Professional | | $1,636.01 | $4,718.16 | $7,465.45 |