- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,174.90 / $4,677.35 / $10,964.78
| Facility | | $1,174.90 | $4,677.35 | $10,964.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $186.21 / $251.19 / $616.60
| Professional | | $186.21 | $251.19 | $616.60 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,388.44 / $7,585.78 / $15,488.17
| Facility | | $3,388.44 | $7,585.78 | $15,488.17 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $67.61 / $275.42 / $977.24
| Professional | | $67.61 | $275.42 | $977.24 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $851.14 / $851.14 / $4,677.35
| Facility | | $851.14 | $851.14 | $4,677.35 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $302.00 / $2,951.21 / $2,951.21
| Professional | | $302.00 | $2,951.21 | $2,951.21 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,862.09 / $5,623.41 / $12,589.25
| Facility | | $1,862.09 | $5,623.41 | $12,589.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $218.78 / $331.13 / $794.33
| Professional | | $218.78 | $331.13 | $794.33 |