- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,862.09 / $5,370.32 / $11,481.54
| Facility | | $1,862.09 | $5,370.32 | $11,481.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,801.89 / $4,570.88 / $8,511.38
| Professional | | $3,801.89 | $4,570.88 | $8,511.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,548.13 / $9,549.93 / $17,782.79
| Facility | | $3,548.13 | $9,549.93 | $17,782.79 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,715.35 / $4,897.79 / $8,709.64
| Professional | | $3,715.35 | $4,897.79 | $8,709.64 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $323.59 / $7,244.36 / $20,417.38
| Facility | | $323.59 | $7,244.36 | $20,417.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,467.37 / $5,623.41 / $11,748.98
| Professional | | $3,467.37 | $5,623.41 | $11,748.98 |
- 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
- $3,467.37 / $4,786.30 / $8,709.64
| Professional | | $3,467.37 | $4,786.30 | $8,709.64 |