- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,011.87 / $6,918.31 / $8,511.38
| Facility | | $5,011.87 | $6,918.31 | $8,511.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $933.25 / $8,128.31 / $15,848.93
| Professional | | $933.25 | $8,128.31 | $15,848.93 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,238.72 / $2,344.23 / $2,398.83
| Facility | | $2,238.72 | $2,344.23 | $2,398.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $13,489.63 / $13,489.63 / $16,595.87
| Professional | | $13,489.63 | $13,489.63 | $16,595.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $151.36 / $436.52 / $758.58
| Professional | | $151.36 | $436.52 | $758.58 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,041.74 / $16,218.10 / $53,703.18
| Facility | | $2,041.74 | $16,218.10 | $53,703.18 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $831.76 / $1,584.89 / $14,454.40
| Professional | | $831.76 | $1,584.89 | $14,454.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,862.09 / $9,549.93 / $13,803.84
| Professional | | $1,862.09 | $9,549.93 | $13,803.84 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,398.83 / $2,398.83 / $2,398.83
| Facility | | $2,398.83 | $2,398.83 | $2,398.83 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9,549.93 / $16,218.10 / $47,863.01
| Facility | | $9,549.93 | $16,218.10 | $47,863.01 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $851.14 / $1,318.26 / $2,691.53
| Professional | | $851.14 | $1,318.26 | $2,691.53 |