- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,265.80 / $6,760.83 / $10,964.78
| Facility | | $4,265.80 | $6,760.83 | $10,964.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $363.08 / $776.25 / $933.25
| Professional | | $363.08 | $776.25 | $933.25 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,290.87 / $6,760.83 / $16,218.10
| Facility | | $2,290.87 | $6,760.83 | $16,218.10 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $389.05 / $812.83 / $812.83
| Professional | | $389.05 | $812.83 | $812.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $398.11 / $512.86 / $758.58
| Professional | | $398.11 | $512.86 | $758.58 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,754.40 / $13,803.84 / $43,651.58
| Facility | | $5,754.40 | $13,803.84 | $43,651.58 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $776.25 / $1,174.90 / $1,819.70
| Professional | | $776.25 | $1,174.90 | $1,819.70 |