- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,862.09 / $5,128.61 / $11,481.54
| Facility | | $1,862.09 | $5,128.61 | $11,481.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,754.23 / $3,311.31 / $7,413.10
| Professional | | $2,754.23 | $3,311.31 | $7,413.10 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,677.35 / $13,803.84 / $28,183.83
| Facility | | $4,677.35 | $13,803.84 | $28,183.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,818.38 / $4,168.69 / $7,943.28
| Professional | | $2,818.38 | $4,168.69 | $7,943.28 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $398.11 / $7,079.46 / $20,892.96
| Facility | | $398.11 | $7,079.46 | $20,892.96 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,019.95 / $4,897.79 / $10,471.29
| Professional | | $3,019.95 | $4,897.79 | $10,471.29 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $851.14 / $3,162.28 / $10,232.93
| Facility | | $851.14 | $3,162.28 | $10,232.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,818.38 / $4,073.80 / $7,585.78
| Professional | | $2,818.38 | $4,073.80 | $7,585.78 |