- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,837.82 / $2,665.32 / $4,659.14
| Facility | | $1,837.82 | $2,665.32 | $4,659.14 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $759.64 / $962.21 / $1,202.77
| Professional | | $759.64 | $962.21 | $1,202.77 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,620.57 / $3,646.28 / $6,109.29
| Facility | | $1,620.57 | $3,646.28 | $6,109.29 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $531.74 / $531.74 / $1,266.07
| Professional | | $531.74 | $531.74 | $1,266.07 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $724.20 / $847.64 / $3,867.87
| Facility | | $724.20 | $847.64 | $3,867.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,550.62 / $1,550.62 / $1,835.80
| Professional | | $1,550.62 | $1,550.62 | $1,835.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $962.21 / $1,266.07 / $1,772.50
| Facility | | $962.21 | $1,266.07 | $1,772.50 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,012.86 / $1,772.50 / $2,532.14
| Professional | | $1,012.86 | $1,772.50 | $2,532.14 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $531.75 / $531.75 / $759.64
| Professional | | $531.75 | $531.75 | $759.64 |