- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,570.40 / $5,623.41 / $8,317.64
| Facility | | $2,570.40 | $5,623.41 | $8,317.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $467.74 / $549.54 / $1,096.48
| Professional | | $467.74 | $549.54 | $1,096.48 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,380.38 / $3,388.44 / $6,918.31
| Facility | | $1,380.38 | $3,388.44 | $6,918.31 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $524.81 / $812.83 / $1,412.54
| Professional | | $524.81 | $812.83 | $1,412.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $891.25 / $1,862.09 / $3,981.07
| Facility | | $891.25 | $1,862.09 | $3,981.07 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $549.54 / $831.76 / $1,318.26
| Professional | | $549.54 | $831.76 | $1,318.26 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $524.81 / $758.58 / $2,818.38
| Professional | | $524.81 | $758.58 | $2,818.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,122.02 / $4,168.69 / $6,918.31
| Facility | | $1,122.02 | $4,168.69 | $6,918.31 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $436.52 / $691.83 / $1,174.90
| Professional | | $436.52 | $691.83 | $1,174.90 |