- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,202.26 / $1,548.82 / $8,709.64
| Facility | | $1,202.26 | $1,548.82 | $8,709.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $933.25 / $1,047.13 / $2,187.76
| Professional | | $933.25 | $1,047.13 | $2,187.76 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $645.65 / $1,230.27 / $1,621.81
| Professional | | $645.65 | $1,230.27 | $1,621.81 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $32.36 / $33.11 / $1,258.93
| Professional | | $32.36 | $33.11 | $1,258.93 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $870.96 / $1,148.15 / $1,949.84
| Facility | | $870.96 | $1,148.15 | $1,949.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $645.65 / $1,202.26 / $1,621.81
| Professional | | $645.65 | $1,202.26 | $1,621.81 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $794.33 / $9,120.11 / $13,803.84
| Facility | | $794.33 | $9,120.11 | $13,803.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $891.25 / $1,202.26 / $1,949.84
| Professional | | $891.25 | $1,202.26 | $1,949.84 |