- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,466.84 / $9,120.11 / $23,988.33
| Facility | | $4,466.84 | $9,120.11 | $23,988.33 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,162.28 / $4,168.69 / $5,011.87
| Professional | | $3,162.28 | $4,168.69 | $5,011.87 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,365.16 / $8,709.64 / $25,118.86
| Facility | | $4,365.16 | $8,709.64 | $25,118.86 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,905.46 / $2,089.30 / $6,456.54
| Professional | | $1,905.46 | $2,089.30 | $6,456.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,388.44 / $8,709.64 / $22,387.21
| Facility | | $3,388.44 | $8,709.64 | $22,387.21 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $6,025.60 / $7,585.78 / $14,454.40
| Professional | | $6,025.60 | $7,585.78 | $14,454.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,162.28 / $5,248.07 / $6,309.57
| Facility | | $3,162.28 | $5,248.07 | $6,309.57 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,187.76 / $3,162.28 / $6,309.57
| Professional | | $2,187.76 | $3,162.28 | $6,309.57 |