- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,202.26 / $3,890.45 / $6,760.83
| Facility | | $1,202.26 | $3,890.45 | $6,760.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $630.96 / $5,495.41 / $8,317.64
| Professional | | $630.96 | $5,495.41 | $8,317.64 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12,589.25 / $19,498.45 / $32,359.37
| Facility | | $12,589.25 | $19,498.45 | $32,359.37 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,235.94 / $8,128.31 / $23,988.33
| Facility | | $3,235.94 | $8,128.31 | $23,988.33 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $426.58 / $891.25 / $52,480.75
| Professional | | $426.58 | $891.25 | $52,480.75 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,467.37 / $11,748.98 / $20,892.96
| Facility | | $3,467.37 | $11,748.98 | $20,892.96 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $398.11 / $724.44 / $1,412.54
| Professional | | $398.11 | $724.44 | $1,412.54 |