- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,128.31 / $8,511.38 / $28,183.83
| Facility | | $8,128.31 | $8,511.38 | $28,183.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $891.25 / $2,344.23 / $5,128.61
| Professional | | $891.25 | $2,344.23 | $5,128.61 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9,120.11 / $16,218.10 / $41,686.94
| Facility | | $9,120.11 | $16,218.10 | $41,686.94 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4,365.16 / $4,677.35 / $6,760.83
| Professional | | $4,365.16 | $4,677.35 | $6,760.83 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,630.27 / $8,128.31 / $15,135.61
| Facility | | $2,630.27 | $8,128.31 | $15,135.61 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,344.23 / $4,677.35 / $24,547.09
| Professional | | $2,344.23 | $4,677.35 | $24,547.09 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,951.21 / $6,309.57 / $12,589.25
| Facility | | $2,951.21 | $6,309.57 | $12,589.25 |