- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,148.15 / $2,884.03 / $5,888.44
| Facility | | $1,148.15 | $2,884.03 | $5,888.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $416.87 / $549.54 / $2,398.83
| Professional | | $416.87 | $549.54 | $2,398.83 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,370.32 / $9,332.54 / $10,964.78
| Facility | | $5,370.32 | $9,332.54 | $10,964.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $489.78 / $645.65 / $1,023.29
| Professional | | $489.78 | $645.65 | $1,023.29 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $457.09 / $562.34 / $831.76
| Professional | | $457.09 | $562.34 | $831.76 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $380.19 / $588.84 / $7,943.28
| Professional | | $380.19 | $588.84 | $7,943.28 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,370.32 / $5,370.32 / $5,370.32
| Facility | | $5,370.32 | $5,370.32 | $5,370.32 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $645.65 / $645.65 / $7,943.28
| Professional | | $645.65 | $645.65 | $7,943.28 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $436.52 / $436.52 / $446.68
| Professional | | $436.52 | $436.52 | $446.68 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,290.87 / $3,548.13 / $10,715.19
| Facility | | $2,290.87 | $3,548.13 | $10,715.19 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $457.09 / $575.44 / $851.14
| Professional | | $457.09 | $575.44 | $851.14 |