- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,467.37 / $5,495.41 / $6,606.93
| Facility | | $3,467.37 | $5,495.41 | $6,606.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,467.37 / $5,370.32 / $7,079.46
| Professional | | $3,467.37 | $5,370.32 | $7,079.46 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $602.56 / $602.56 / $16,982.44
| Facility | | $602.56 | $602.56 | $16,982.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,630.27 / $4,466.84 / $8,709.64
| Professional | | $2,630.27 | $4,466.84 | $8,709.64 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,090.30 / $3,090.30 / $4,897.79
| Facility | | $3,090.30 | $3,090.30 | $4,897.79 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,630.27 / $3,090.30 / $13,182.57
| Professional | | $2,630.27 | $3,090.30 | $13,182.57 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $281.84 / $933.25 / $4,073.80
| Facility | | $281.84 | $933.25 | $4,073.80 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,995.26 / $2,951.21 / $5,011.87
| Professional | | $1,995.26 | $2,951.21 | $5,011.87 |