- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,019.95 / $4,897.79 / $9,772.37
| Facility | | $3,019.95 | $4,897.79 | $9,772.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $331.13 / $512.86 / $1,584.89
| Professional | | $331.13 | $512.86 | $1,584.89 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,071.52 / $1,071.52 / $1,445.44
| Professional | | $1,071.52 | $1,071.52 | $1,445.44 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $398.11 / $676.08 / $3,162.28
| Facility | | $398.11 | $676.08 | $3,162.28 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $575.44 / $1,548.82 / $3,019.95
| Professional | | $575.44 | $1,548.82 | $3,019.95 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,380.38 / $1,905.46 / $2,511.89
| Professional | | $1,380.38 | $1,905.46 | $2,511.89 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $616.60 / $1,621.81 / $3,090.30
| Facility | | $616.60 | $1,621.81 | $3,090.30 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $60.26 / $426.58 / $1,445.44
| Professional | | $60.26 | $426.58 | $1,445.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $602.56 / $1,148.15 / $2,137.96
| Professional | | $602.56 | $1,148.15 | $2,137.96 |