- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,380.38 / $5,248.07 / $12,022.64
| Facility | | $1,380.38 | $5,248.07 | $12,022.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $954.99 / $1,230.27 / $2,754.23
| Professional | | $954.99 | $1,230.27 | $2,754.23 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,388.44 / $9,549.93 / $17,782.79
| Facility | | $3,388.44 | $9,549.93 | $17,782.79 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $831.76 / $1,318.26 / $2,570.40
| Professional | | $831.76 | $1,318.26 | $2,570.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,380.38 / $3,090.30 / $8,317.64
| Facility | | $1,380.38 | $3,090.30 | $8,317.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $912.01 / $1,584.89 / $3,630.78
| Professional | | $912.01 | $1,584.89 | $3,630.78 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,511.89 / $7,244.36 / $16,218.10
| Facility | | $2,511.89 | $7,244.36 | $16,218.10 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $870.96 / $1,258.93 / $2,398.83
| Professional | | $870.96 | $1,258.93 | $2,398.83 |