- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,548.13 / $5,011.87 / $10,471.29
| Facility | | $3,548.13 | $5,011.87 | $10,471.29 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,570.40 / $2,570.40 / $2,884.03
| Professional | | $2,570.40 | $2,570.40 | $2,884.03 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $181.97 / $5,495.41 / $9,549.93
| Facility | | $181.97 | $5,495.41 | $9,549.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $204.17 / $1,148.15 / $2,691.53
| Professional | | $204.17 | $1,148.15 | $2,691.53 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,290.87 / $3,548.13 / $14,125.38
| Facility | | $2,290.87 | $3,548.13 | $14,125.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $38.02 / $4,073.80 / $5,011.87
| Professional | | $38.02 | $4,073.80 | $5,011.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,659.59 / $1,659.59 / $2,089.30
| Professional | | $1,659.59 | $1,659.59 | $2,089.30 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,479.11 / $2,630.27 / $6,165.95
| Professional | | $1,479.11 | $2,630.27 | $6,165.95 |