- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,248.07 / $9,120.11 / $16,595.87
| Facility | | $5,248.07 | $9,120.11 | $16,595.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,890.45 / $4,677.35 / $8,128.31
| Professional | | $3,890.45 | $4,677.35 | $8,128.31 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,981.07 / $4,677.35 / $7,943.28
| Professional | | $3,981.07 | $4,677.35 | $7,943.28 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4,570.88 / $5,754.40 / $9,549.93
| Professional | | $4,570.88 | $5,754.40 | $9,549.93 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,365.16 / $6,165.95 / $10,964.78
| Facility | | $4,365.16 | $6,165.95 | $10,964.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $32.36 / $32.36 / $33.11
| Professional | | $32.36 | $32.36 | $33.11 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,454.71 / $6,760.83 / $9,120.11
| Facility | | $2,454.71 | $6,760.83 | $9,120.11 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,715.35 / $5,128.61 / $9,120.11
| Professional | | $3,715.35 | $5,128.61 | $9,120.11 |