- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,162.28 / $3,388.44 / $6,025.60
| Facility | | $3,162.28 | $3,388.44 | $6,025.60 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,290.87 / $3,388.44 / $14,791.08
| Professional | | $2,290.87 | $3,388.44 | $14,791.08 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,344.23 / $3,467.37 / $6,025.60
| Professional | | $2,344.23 | $3,467.37 | $6,025.60 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $32.36 / $33.11 / $2,089.30
| Professional | | $32.36 | $33.11 | $2,089.30 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $25,703.96 / $30,199.52 / $67,608.30
| Facility | | $25,703.96 | $30,199.52 | $67,608.30 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,548.13 / $4,786.30 / $7,244.36
| Professional | | $3,548.13 | $4,786.30 | $7,244.36 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,454.71 / $4,786.30 / $6,760.83
| Professional | | $2,454.71 | $4,786.30 | $6,760.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,388.44 / $4,466.84 / $6,309.57
| Professional | | $3,388.44 | $4,466.84 | $6,309.57 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,311.31 / $5,128.61 / $24,547.09
| Facility | | $3,311.31 | $5,128.61 | $24,547.09 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,187.76 / $2,818.38 / $4,466.84
| Professional | | $2,187.76 | $2,818.38 | $4,466.84 |