- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,862.09 / $5,495.41 / $11,748.98
| Facility | | $1,862.09 | $5,495.41 | $11,748.98 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4,073.80 / $4,786.30 / $9,120.11
| Professional | | $4,073.80 | $4,786.30 | $9,120.11 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,073.80 / $11,481.54 / $22,387.21
| Facility | | $4,073.80 | $11,481.54 | $22,387.21 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,630.27 / $4,570.88 / $9,332.54
| Professional | | $2,630.27 | $4,570.88 | $9,332.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $371.54 / $7,585.78 / $20,892.96
| Facility | | $371.54 | $7,585.78 | $20,892.96 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,511.89 / $5,888.44 / $12,022.64
| Professional | | $2,511.89 | $5,888.44 | $12,022.64 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $537.03 / $2,818.38 / $9,772.37
| Facility | | $537.03 | $2,818.38 | $9,772.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,388.44 / $5,011.87 / $9,332.54
| Professional | | $3,388.44 | $5,011.87 | $9,332.54 |