- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,011.87 / $6,606.93 / $12,302.69
| Facility | | $5,011.87 | $6,606.93 | $12,302.69 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4,786.30 / $6,606.93 / $11,220.18
| Professional | | $4,786.30 | $6,606.93 | $11,220.18 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,011.87 / $6,918.31 / $25,118.86
| Facility | | $5,011.87 | $6,918.31 | $25,118.86 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $6,606.93 / $6,760.83 / $15,135.61
| Professional | | $6,606.93 | $6,760.83 | $15,135.61 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,709.64 / $8,709.64 / $51,286.14
| Facility | | $8,709.64 | $8,709.64 | $51,286.14 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $6,309.57 / $6,309.57 / $19,498.45
| Professional | | $6,309.57 | $6,309.57 | $19,498.45 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,570.88 / $8,317.64 / $15,135.61
| Facility | | $4,570.88 | $8,317.64 | $15,135.61 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4,570.88 / $6,309.57 / $9,549.93
| Professional | | $4,570.88 | $6,309.57 | $9,549.93 |