- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,719.53 / $14,785.30 / $27,978.30
| Facility | | $8,719.53 | $14,785.30 | $27,978.30 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,666.54 / $2,666.54 / $2,666.54
| Professional | | $2,666.54 | $2,666.54 | $2,666.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $846.27 / $22,746.60 / $41,163.76
| Facility | | $846.27 | $22,746.60 | $41,163.76 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $719.32 / $846.27 / $1,142.46
| Professional | | $719.32 | $846.27 | $1,142.46 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,582.20 / $9,856.86 / $14,785.29
| Facility | | $7,582.20 | $9,856.86 | $14,785.29 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $7,582.20 / $9,098.64 / $11,373.30
| Professional | | $7,582.20 | $9,098.64 | $11,373.30 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,928.43 / $14,330.63 / $29,570.02
| Facility | | $4,928.43 | $14,330.63 | $29,570.02 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,117.08 / $9,235.41 / $11,065.06
| Professional | | $1,117.08 | $9,235.41 | $11,065.06 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,184.52 / $4,549.32 / $8,332.84
| Professional | | $3,184.52 | $4,549.32 | $8,332.84 |