- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,162.28 / $4,365.16 / $5,754.40
| Facility | | $3,162.28 | $4,365.16 | $5,754.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,570.40 / $4,168.69 / $5,623.41
| Professional | | $2,570.40 | $4,168.69 | $5,623.41 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $537.03 / $537.03 / $13,182.57
| Facility | | $537.03 | $537.03 | $13,182.57 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,090.30 / $5,011.87 / $7,244.36
| Professional | | $3,090.30 | $5,011.87 | $7,244.36 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,128.61 / $5,128.61 / $5,370.32
| Facility | | $5,128.61 | $5,128.61 | $5,370.32 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $616.60 / $5,128.61 / $10,471.29
| Professional | | $616.60 | $5,128.61 | $10,471.29 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $275.42 / $812.83 / $3,388.44
| Facility | | $275.42 | $812.83 | $3,388.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,737.80 / $2,454.71 / $5,011.87
| Professional | | $1,737.80 | $2,454.71 | $5,011.87 |