- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,011.87 / $9,120.11 / $16,595.87
| Facility | | $5,011.87 | $9,120.11 | $16,595.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,715.35 / $4,786.30 / $9,772.37
| Professional | | $3,715.35 | $4,786.30 | $9,772.37 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,137.96 / $7,413.10 / $12,589.25
| Facility | | $2,137.96 | $7,413.10 | $12,589.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $489.78 / $5,248.07 / $9,549.93
| Professional | | $489.78 | $5,248.07 | $9,549.93 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,073.80 / $6,165.95 / $10,964.78
| Facility | | $4,073.80 | $6,165.95 | $10,964.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $30.20 / $30.20 / $54.95
| Professional | | $30.20 | $30.20 | $54.95 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,454.71 / $6,918.31 / $11,220.18
| Facility | | $2,454.71 | $6,918.31 | $11,220.18 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,467.37 / $4,365.16 / $7,585.78
| Professional | | $3,467.37 | $4,365.16 | $7,585.78 |