- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,265.80 / $10,964.78 / $28,183.83
| Facility | | $4,265.80 | $10,964.78 | $28,183.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,388.44 / $4,168.69 / $5,370.32
| Professional | | $3,388.44 | $4,168.69 | $5,370.32 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,290.87 / $7,413.10 / $11,220.18
| Facility | | $2,290.87 | $7,413.10 | $11,220.18 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4,570.88 / $4,786.30 / $9,120.11
| Professional | | $4,570.88 | $4,786.30 | $9,120.11 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,311.31 / $4,265.80 / $11,748.98
| Facility | | $3,311.31 | $4,265.80 | $11,748.98 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,630.78 / $5,495.41 / $10,471.29
| Facility | | $3,630.78 | $5,495.41 | $10,471.29 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,290.87 / $2,290.87 / $27,542.29
| Professional | | $2,290.87 | $2,290.87 | $27,542.29 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,897.79 / $5,495.41 / $6,606.93
| Facility | | $4,897.79 | $5,495.41 | $6,606.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,290.87 / $2,290.87 / $3,311.31
| Professional | | $2,290.87 | $2,290.87 | $3,311.31 |