- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,023.29 / $7,244.36 / $9,772.37
| Facility | | $1,023.29 | $7,244.36 | $9,772.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $851.14 / $1,023.29 / $3,467.37
| Professional | | $851.14 | $1,023.29 | $3,467.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,071.52 / $19,952.62 / $44,668.36
| Professional | | $1,071.52 | $19,952.62 | $44,668.36 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $13,803.84 / $20,417.38 / $37,153.52
| Facility | | $13,803.84 | $20,417.38 | $37,153.52 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,174.90 / $1,445.44 / $4,365.16
| Professional | | $1,174.90 | $1,445.44 | $4,365.16 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,238.72 / $2,238.72 / $2,398.83
| Professional | | $2,238.72 | $2,238.72 | $2,398.83 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,897.79 / $13,489.63 / $57,543.99
| Facility | | $4,897.79 | $13,489.63 | $57,543.99 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $912.01 / $1,513.56 / $2,570.40
| Professional | | $912.01 | $1,513.56 | $2,570.40 |