- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,511.89 / $6,309.57 / $23,442.29
| Facility | | $2,511.89 | $6,309.57 | $23,442.29 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,454.71 / $2,951.21 / $4,897.79
| Professional | | $2,454.71 | $2,951.21 | $4,897.79 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,344.23 / $2,951.21 / $7,413.10
| Facility | | $2,344.23 | $2,951.21 | $7,413.10 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,090.30 / $3,090.30 / $7,244.36
| Professional | | $3,090.30 | $3,090.30 | $7,244.36 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,570.88 / $4,570.88 / $23,442.29
| Facility | | $4,570.88 | $4,570.88 | $23,442.29 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,890.45 / $3,890.45 / $8,317.64
| Professional | | $3,890.45 | $3,890.45 | $8,317.64 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,995.26 / $3,548.13 / $3,981.07
| Facility | | $1,995.26 | $3,548.13 | $3,981.07 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,137.96 / $2,884.03 / $4,365.16
| Professional | | $2,137.96 | $2,884.03 | $4,365.16 |