- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,219.10 / $8,377.96 / $21,848.40
| Facility | | $4,219.10 | $8,377.96 | $21,848.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,641.41 / $4,544.91 / $4,654.43
| Professional | | $3,641.41 | $4,544.91 | $4,654.43 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,508.44 / $9,526.36 / $15,091.09
| Facility | | $2,508.44 | $9,526.36 | $15,091.09 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,171.61 / $4,613.25 / $22,345.42
| Professional | | $3,171.61 | $4,613.25 | $22,345.42 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,180.47 / $8,542.25 / $15,304.86
| Facility | | $3,180.47 | $8,542.25 | $15,304.86 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,668.79 / $5,475.80 / $10,424.18
| Facility | | $3,668.79 | $5,475.80 | $10,424.18 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,299.84 / $2,299.84 / $27,269.48
| Professional | | $2,299.84 | $2,299.84 | $27,269.48 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,299.84 / $2,299.84 / $3,285.48
| Professional | | $2,299.84 | $2,299.84 | $3,285.48 |