- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,890.45 / $3,981.07 / $18,197.01
| Facility | | $3,890.45 | $3,981.07 | $18,197.01 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,819.70 / $2,398.83 / $2,818.38
| Professional | | $1,819.70 | $2,398.83 | $2,818.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,467.37 / $6,606.93 / $13,803.84
| Facility | | $3,467.37 | $6,606.93 | $13,803.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,162.28 / $4,073.80 / $6,606.93
| Professional | | $3,162.28 | $4,073.80 | $6,606.93 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $134.90 / $11,481.54 / $25,703.96
| Facility | | $134.90 | $11,481.54 | $25,703.96 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,398.83 / $2,884.03 / $3,090.30
| Professional | | $2,398.83 | $2,884.03 | $3,090.30 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,412.54 / $3,019.95 / $6,165.95
| Facility | | $1,412.54 | $3,019.95 | $6,165.95 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,202.26 / $1,819.70 / $3,162.28
| Professional | | $1,202.26 | $1,819.70 | $3,162.28 |