- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,570.88 / $12,022.64 / $16,595.87
| Facility | | $4,570.88 | $12,022.64 | $16,595.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,584.89 / $2,041.74 / $8,709.64
| Professional | | $1,584.89 | $2,041.74 | $8,709.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5,248.07 / $5,248.07 / $5,248.07
| Professional | | $5,248.07 | $5,248.07 | $5,248.07 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,862.09 / $2,290.87 / $12,022.64
| Facility | | $1,862.09 | $2,290.87 | $12,022.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,715.35 / $4,786.30 / $10,471.29
| Professional | | $3,715.35 | $4,786.30 | $10,471.29 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5,754.40 / $6,165.95 / $8,709.64
| Professional | | $5,754.40 | $6,165.95 | $8,709.64 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,290.87 / $8,709.64 / $12,302.69
| Facility | | $2,290.87 | $8,709.64 | $12,302.69 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $60.26 / $1,513.56 / $5,248.07
| Professional | | $60.26 | $1,513.56 | $5,248.07 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,089.30 / $6,309.57 / $9,772.37
| Professional | | $2,089.30 | $6,309.57 | $9,772.37 |