- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,041.74 / $5,623.41 / $12,882.50
| Facility | | $2,041.74 | $5,623.41 | $12,882.50 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,801.89 / $3,890.45 / $6,025.60
| Professional | | $3,801.89 | $3,890.45 | $6,025.60 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,570.88 / $9,332.54 / $26,915.35
| Facility | | $4,570.88 | $9,332.54 | $26,915.35 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $33.88 / $158.49 / $263.03
| Professional | | $33.88 | $158.49 | $263.03 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $64.57 / $7,762.47 / $18,620.87
| Facility | | $64.57 | $7,762.47 | $18,620.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5,128.61 / $5,128.61 / $5,128.61
| Professional | | $5,128.61 | $5,128.61 | $5,128.61 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,951.21 / $8,709.64 / $19,952.62
| Facility | | $2,951.21 | $8,709.64 | $19,952.62 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $15,135.61 / $19,952.62 / $34,673.69
| Professional | | $15,135.61 | $19,952.62 | $34,673.69 |