- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,096.48 / $3,467.37 / $4,897.79
| Facility | | $1,096.48 | $3,467.37 | $4,897.79 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $630.96 / $741.31 / $1,348.96
| Professional | | $630.96 | $741.31 | $1,348.96 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,456.54 / $14,454.40 / $19,498.45
| Facility | | $6,456.54 | $14,454.40 | $19,498.45 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $645.65 / $812.83 / $1,318.26
| Professional | | $645.65 | $812.83 | $1,318.26 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $660.69 / $724.44 / $831.76
| Facility | | $660.69 | $724.44 | $831.76 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $691.83 / $912.01 / $1,412.54
| Professional | | $691.83 | $912.01 | $1,412.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,011.87 / $11,481.54 / $17,378.01
| Facility | | $5,011.87 | $11,481.54 | $17,378.01 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $575.44 / $758.58 / $1,288.25
| Professional | | $575.44 | $758.58 | $1,288.25 |