- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,949.84 / $5,011.87 / $11,748.98
| Facility | | $1,949.84 | $5,011.87 | $11,748.98 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,238.72 / $2,754.23 / $6,025.60
| Professional | | $2,238.72 | $2,754.23 | $6,025.60 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,715.35 / $10,964.78 / $22,908.68
| Facility | | $3,715.35 | $10,964.78 | $22,908.68 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,290.87 / $3,388.44 / $6,165.95
| Professional | | $2,290.87 | $3,388.44 | $6,165.95 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $323.59 / $6,760.83 / $19,054.61
| Facility | | $323.59 | $6,760.83 | $19,054.61 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,454.71 / $3,801.89 / $8,128.31
| Professional | | $2,454.71 | $3,801.89 | $8,128.31 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,041.74 / $7,244.36 / $16,982.44
| Facility | | $2,041.74 | $7,244.36 | $16,982.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,137.96 / $3,019.95 / $5,754.40
| Professional | | $2,137.96 | $3,019.95 | $5,754.40 |