- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $933.25 / $4,897.79 / $11,220.18
| Facility | | $933.25 | $4,897.79 | $11,220.18 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $562.34 / $630.96 / $1,348.96
| Professional | | $562.34 | $630.96 | $1,348.96 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,168.69 / $30,199.52 / $39,810.72
| Facility | | $4,168.69 | $30,199.52 | $39,810.72 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $575.44 / $794.33 / $1,288.25
| Professional | | $575.44 | $794.33 | $1,288.25 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $562.34 / $630.96 / $707.95
| Facility | | $562.34 | $630.96 | $707.95 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $630.96 / $954.99 / $1,380.38
| Professional | | $630.96 | $954.99 | $1,380.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,073.80 / $7,762.47 / $10,964.78
| Facility | | $4,073.80 | $7,762.47 | $10,964.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $501.19 / $660.69 / $1,148.15
| Professional | | $501.19 | $660.69 | $1,148.15 |