- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,526.58 / $9,639.37 / $19,278.80
| Facility | | $5,526.58 | $9,639.37 | $19,278.80 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,552.73 / $4,284.17 / $4,440.91
| Professional | | $3,552.73 | $4,284.17 | $4,440.91 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,224.60 / $15,673.80 / $28,364.35
| Facility | | $5,224.60 | $15,673.80 | $28,364.35 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $56.27 / $66.20 / $5,747.06
| Professional | | $56.27 | $66.20 | $5,747.06 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,224.60 / $6,791.98 / $10,187.96
| Facility | | $5,224.60 | $6,791.98 | $10,187.96 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5,224.60 / $6,269.52 / $7,836.90
| Professional | | $5,224.60 | $6,269.52 | $7,836.90 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,395.99 / $9,874.51 / $20,375.68
| Facility | | $3,395.99 | $9,874.51 | $20,375.68 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $6,003.78 / $6,398.83 / $15,248.91
| Professional | | $6,003.78 | $6,398.83 | $15,248.91 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,194.33 / $3,134.76 / $5,741.84
| Professional | | $2,194.33 | $3,134.76 | $5,741.84 |