- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,570.88 / $4,897.79 / $10,471.29
| Facility | | $4,570.88 | $4,897.79 | $10,471.29 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,137.96 / $2,818.38 / $7,079.46
| Professional | | $2,137.96 | $2,818.38 | $7,079.46 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,912.51 / $21,877.62 / $26,915.35
| Facility | | $8,912.51 | $21,877.62 | $26,915.35 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,290.87 / $4,570.88 / $6,025.60
| Professional | | $2,290.87 | $4,570.88 | $6,025.60 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,818.38 / $4,073.80 / $6,309.57
| Professional | | $2,818.38 | $4,073.80 | $6,309.57 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4,168.69 / $4,168.69 / $4,365.16
| Professional | | $4,168.69 | $4,168.69 | $4,365.16 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,311.31 / $6,165.95 / $15,135.61
| Facility | | $3,311.31 | $6,165.95 | $15,135.61 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,398.83 / $3,388.44 / $6,918.31
| Professional | | $2,398.83 | $3,388.44 | $6,918.31 |