- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,897.79 / $8,317.64 / $9,772.37
| Facility | | $4,897.79 | $8,317.64 | $9,772.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,311.31 / $4,265.80 / $5,754.40
| Professional | | $3,311.31 | $4,265.80 | $5,754.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,011.87 / $5,011.87 / $17,378.01
| Facility | | $5,011.87 | $5,011.87 | $17,378.01 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,995.26 / $3,311.31 / $8,317.64
| Professional | | $1,995.26 | $3,311.31 | $8,317.64 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,456.54 / $9,549.93 / $12,022.64
| Facility | | $6,456.54 | $9,549.93 | $12,022.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5,754.40 / $5,754.40 / $5,754.40
| Professional | | $5,754.40 | $5,754.40 | $5,754.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,365.16 / $6,025.60 / $23,988.33
| Facility | | $4,365.16 | $6,025.60 | $23,988.33 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,089.30 / $3,019.95 / $25,118.86
| Professional | | $2,089.30 | $3,019.95 | $25,118.86 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,089.30 / $5,011.87 / $6,025.60
| Facility | | $2,089.30 | $5,011.87 | $6,025.60 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,089.30 / $3,019.95 / $5,495.41
| Professional | | $2,089.30 | $3,019.95 | $5,495.41 |