- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,548.13 / $12,022.64 / $16,595.87
| Facility | | $3,548.13 | $12,022.64 | $16,595.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,096.48 / $1,479.11 / $5,370.32
| Professional | | $1,096.48 | $1,479.11 | $5,370.32 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,981.07 / $3,981.07 / $3,981.07
| Professional | | $3,981.07 | $3,981.07 | $3,981.07 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,148.15 / $1,862.09 / $7,585.78
| Facility | | $1,148.15 | $1,862.09 | $7,585.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,570.40 / $3,311.31 / $8,128.31
| Professional | | $2,570.40 | $3,311.31 | $8,128.31 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4,677.35 / $4,677.35 / $7,244.36
| Professional | | $4,677.35 | $4,677.35 | $7,244.36 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,905.46 / $5,370.32 / $7,762.47
| Facility | | $1,905.46 | $5,370.32 | $7,762.47 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $60.26 / $1,122.02 / $3,981.07
| Professional | | $60.26 | $1,122.02 | $3,981.07 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,884.03 / $3,235.94 / $7,413.10
| Professional | | $2,884.03 | $3,235.94 | $7,413.10 |