- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,754.23 / $2,754.23 / $6,309.57
| Facility | | $2,754.23 | $2,754.23 | $6,309.57 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $457.09 / $457.09 / $2,691.53
| Professional | | $457.09 | $457.09 | $2,691.53 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,388.44 / $4,570.88 / $7,413.10
| Facility | | $3,388.44 | $4,570.88 | $7,413.10 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $208.93 / $1,778.28 / $5,623.41
| Professional | | $208.93 | $1,778.28 | $5,623.41 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,778.28 / $9,549.93 / $13,803.84
| Facility | | $1,778.28 | $9,549.93 | $13,803.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,715.35 / $5,128.61 / $6,025.60
| Professional | | $3,715.35 | $5,128.61 | $6,025.60 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,318.26 / $1,659.59 / $4,786.30
| Professional | | $1,318.26 | $1,659.59 | $4,786.30 |