- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,023.29 / $4,786.30 / $11,481.54
| Facility | | $1,023.29 | $4,786.30 | $11,481.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $512.86 / $602.56 / $1,380.38
| Professional | | $512.86 | $602.56 | $1,380.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,090.30 / $8,317.64 / $15,488.17
| Facility | | $3,090.30 | $8,317.64 | $15,488.17 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $512.86 / $741.31 / $1,412.54
| Professional | | $512.86 | $741.31 | $1,412.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $851.14 / $1,659.59 / $4,466.84
| Facility | | $851.14 | $1,659.59 | $4,466.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $562.34 / $831.76 / $1,819.70
| Professional | | $562.34 | $831.76 | $1,819.70 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,949.84 / $5,495.41 / $12,302.69
| Facility | | $1,949.84 | $5,495.41 | $12,302.69 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $478.63 / $660.69 / $1,258.93
| Professional | | $478.63 | $660.69 | $1,258.93 |