- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,811.44 / $6,177.63 / $17,571.50
| Facility | | $2,811.44 | $6,177.63 | $17,571.50 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,957.96 / $2,169.31 / $2,510.21
| Professional | | $1,957.96 | $2,169.31 | $2,510.21 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,129.30 / $4,859.26 / $12,499.09
| Facility | | $4,129.30 | $4,859.26 | $12,499.09 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,004.08 / $1,631.63 / $1,631.64
| Professional | | $1,004.08 | $1,631.63 | $1,631.64 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,643.64 / $8,058.65 / $10,690.51
| Facility | | $4,643.64 | $8,058.65 | $10,690.51 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,300.36 / $4,904.33 / $10,430.31
| Professional | | $1,300.36 | $4,904.33 | $10,430.31 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,510.21 / $3,643.32 / $8,931.08
| Professional | | $2,510.21 | $3,643.32 | $8,931.08 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,054.29 / $1,506.13 / $1,859.41
| Professional | | $1,054.29 | $1,506.13 | $1,859.41 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,289.73 / $2,518.71 / $3,205.64
| Professional | | $2,289.73 | $2,518.71 | $3,205.64 |