- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,621.81 / $7,762.47 / $18,620.87
| Facility | | $1,621.81 | $7,762.47 | $18,620.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,380.38 / $1,698.24 / $2,089.30
| Professional | | $1,380.38 | $1,698.24 | $2,089.30 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $13,803.84 / $20,417.38 / $37,153.52
| Facility | | $13,803.84 | $20,417.38 | $37,153.52 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,311.31 / $3,311.31 / $3,801.89
| Professional | | $3,311.31 | $3,311.31 | $3,801.89 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $645.65 / $2,344.23 / $16,218.10
| Facility | | $645.65 | $2,344.23 | $16,218.10 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,778.28 / $2,630.27 / $5,248.07
| Professional | | $1,778.28 | $2,630.27 | $5,248.07 |