- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,513.56 / $6,165.95 / $15,135.61
| Facility | | $1,513.56 | $6,165.95 | $15,135.61 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $416.87 / $575.44 / $1,122.02
| Professional | | $416.87 | $575.44 | $1,122.02 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,128.61 / $11,748.98 / $28,840.32
| Facility | | $5,128.61 | $11,748.98 | $28,840.32 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $478.63 / $660.69 / $1,258.93
| Professional | | $478.63 | $660.69 | $1,258.93 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,479.11 / $21,379.62 / $33,113.11
| Facility | | $1,479.11 | $21,379.62 | $33,113.11 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $812.83 / $1,122.02 / $3,890.45
| Professional | | $812.83 | $1,122.02 | $3,890.45 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,754.40 / $22,908.68 / $63,095.73
| Facility | | $5,754.40 | $22,908.68 | $63,095.73 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $537.03 / $812.83 / $1,513.56
| Professional | | $537.03 | $812.83 | $1,513.56 |