- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,168.69 / $6,606.93 / $8,128.31
| Facility | | $4,168.69 | $6,606.93 | $8,128.31 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4,168.69 / $6,456.54 / $8,709.64
| Professional | | $4,168.69 | $6,456.54 | $8,709.64 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $724.44 / $724.44 / $20,417.38
| Facility | | $724.44 | $724.44 | $20,417.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,019.95 / $5,495.41 / $10,471.29
| Professional | | $3,019.95 | $5,495.41 | $10,471.29 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,715.35 / $3,715.35 / $5,370.32
| Facility | | $3,715.35 | $3,715.35 | $5,370.32 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,162.28 / $3,715.35 / $16,218.10
| Professional | | $3,162.28 | $3,715.35 | $16,218.10 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $338.84 / $1,122.02 / $4,897.79
| Facility | | $338.84 | $1,122.02 | $4,897.79 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,398.83 / $3,548.13 / $6,165.95
| Professional | | $2,398.83 | $3,548.13 | $6,165.95 |