- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,148.15 / $4,677.35 / $11,481.54
| Facility | | $1,148.15 | $4,677.35 | $11,481.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $489.78 / $794.33 / $1,995.26
| Professional | | $489.78 | $794.33 | $1,995.26 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,570.40 / $5,248.07 / $15,135.61
| Facility | | $2,570.40 | $5,248.07 | $15,135.61 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $588.84 / $870.96 / $1,412.54
| Professional | | $588.84 | $870.96 | $1,412.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $512.86 / $1,479.11 / $7,079.46
| Facility | | $512.86 | $1,479.11 | $7,079.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,071.52 / $1,348.96 / $3,388.44
| Professional | | $1,071.52 | $1,348.96 | $3,388.44 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,318.26 / $5,128.61 / $12,882.50
| Facility | | $1,318.26 | $5,128.61 | $12,882.50 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $269.15 / $741.31 / $1,412.54
| Professional | | $269.15 | $741.31 | $1,412.54 |