- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,495.41 / $19,054.61 / $30,199.52
| Facility | | $5,495.41 | $19,054.61 | $30,199.52 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,951.21 / $4,168.69 / $5,370.32
| Professional | | $2,951.21 | $4,168.69 | $5,370.32 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,079.46 / $15,848.93 / $26,302.68
| Facility | | $7,079.46 | $15,848.93 | $26,302.68 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,290.87 / $2,290.87 / $5,495.41
| Professional | | $2,290.87 | $2,290.87 | $5,495.41 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,951.21 / $3,548.13 / $16,595.87
| Facility | | $2,951.21 | $3,548.13 | $16,595.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $6,606.93 / $6,760.83 / $7,943.28
| Professional | | $6,606.93 | $6,760.83 | $7,943.28 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $7,585.78 / $7,585.78 / $7,762.47
| Professional | | $7,585.78 | $7,585.78 | $7,762.47 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,801.89 / $5,495.41 / $5,495.41
| Professional | | $3,801.89 | $5,495.41 | $5,495.41 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,290.87 / $2,290.87 / $3,311.31
| Professional | | $2,290.87 | $2,290.87 | $3,311.31 |