- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,538.08 / $7,539.10 / $27,480.30
| Facility | | $5,538.08 | $7,539.10 | $27,480.30 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,134.76 / $6,217.27 / $6,791.98
| Professional | | $3,134.76 | $6,217.27 | $6,791.98 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,657.20 / $10,203.12 / $16,077.14
| Facility | | $5,657.20 | $10,203.12 | $16,077.14 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $896.87 / $986.55 / $1,095.07
| Professional | | $896.87 | $986.55 | $1,095.07 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,224.60 / $5,224.60 / $5,224.60
| Facility | | $5,224.60 | $5,224.60 | $5,224.60 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,395.99 / $4,207.63 / $39,667.66
| Facility | | $3,395.99 | $4,207.63 | $39,667.66 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,194.33 / $4,702.14 / $5,224.60
| Facility | | $2,194.33 | $4,702.14 | $5,224.60 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,194.33 / $2,612.30 / $6,530.75
| Professional | | $2,194.33 | $2,612.30 | $6,530.75 |