- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,122.02 / $5,623.41 / $14,454.40
| Facility | | $1,122.02 | $5,623.41 | $14,454.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $288.40 / $1,318.26 / $2,511.89
| Professional | | $288.40 | $1,318.26 | $2,511.89 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,818.38 / $6,165.95 / $13,803.84
| Facility | | $2,818.38 | $6,165.95 | $13,803.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $316.23 / $1,548.82 / $4,073.80
| Professional | | $316.23 | $1,548.82 | $4,073.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $302.00 / $3,630.78 / $10,715.19
| Facility | | $302.00 | $3,630.78 | $10,715.19 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $331.13 / $1,096.48 / $4,073.80
| Professional | | $331.13 | $1,096.48 | $4,073.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,995.26 / $5,623.41 / $12,302.69
| Facility | | $1,995.26 | $5,623.41 | $12,302.69 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $295.12 / $1,348.96 / $3,388.44
| Professional | | $295.12 | $1,348.96 | $3,388.44 |