- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,288.25 / $4,897.79 / $16,218.10
| Facility | | $1,288.25 | $4,897.79 | $16,218.10 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $758.58 / $870.96 / $1,584.89
| Professional | | $758.58 | $870.96 | $1,584.89 |
- 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
- $758.58 / $1,047.13 / $1,698.24
| Professional | | $758.58 | $1,047.13 | $1,698.24 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $776.25 / $870.96 / $977.24
| Facility | | $776.25 | $870.96 | $977.24 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $831.76 / $1,071.52 / $1,819.70
| Professional | | $831.76 | $1,071.52 | $1,819.70 |
- 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
- $691.83 / $891.25 / $1,548.82
| Professional | | $691.83 | $891.25 | $1,548.82 |