- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,951.21 / $4,897.79 / $10,471.29
| Facility | | $2,951.21 | $4,897.79 | $10,471.29 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,380.38 / $1,737.80 / $4,168.69
| Professional | | $1,380.38 | $1,737.80 | $4,168.69 |
- 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
- $1,513.56 / $2,951.21 / $3,801.89
| Professional | | $1,513.56 | $2,951.21 | $3,801.89 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,819.70 / $2,570.40 / $4,168.69
| Professional | | $1,819.70 | $2,570.40 | $4,168.69 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,691.53 / $2,691.53 / $3,090.30
| Professional | | $2,691.53 | $2,691.53 | $3,090.30 |
- 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
- $1,479.11 / $2,187.76 / $4,466.84
| Professional | | $1,479.11 | $2,187.76 | $4,466.84 |