- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,370.32 / $11,481.54 / $26,915.35
| Facility | | $5,370.32 | $11,481.54 | $26,915.35 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $7,762.47 / $7,762.47 / $10,715.19
| Professional | | $7,762.47 | $7,762.47 | $10,715.19 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $21,379.62 / $30,199.52 / $72,443.60
| Facility | | $21,379.62 | $30,199.52 | $72,443.60 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,023.29 / $8,709.64 / $33,113.11
| Professional | | $1,023.29 | $8,709.64 | $33,113.11 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,388.44 / $8,912.51 / $17,782.79
| Facility | | $3,388.44 | $8,912.51 | $17,782.79 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $549.54 / $7,244.36 / $17,378.01
| Professional | | $549.54 | $7,244.36 | $17,378.01 |