- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,090.30 / $5,370.32 / $10,715.19
| Facility | | $3,090.30 | $5,370.32 | $10,715.19 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $269.15 / $309.03 / $645.65
| Professional | | $269.15 | $309.03 | $645.65 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,467.37 / $6,456.54 / $10,964.78
| Facility | | $3,467.37 | $6,456.54 | $10,964.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $288.40 / $363.08 / $512.86
| Professional | | $288.40 | $363.08 | $512.86 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $331.13 / $407.38 / $549.54
| Professional | | $331.13 | $407.38 | $549.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $346.74 / $1,318.26 / $1,318.26
| Professional | | $346.74 | $1,318.26 | $1,318.26 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $245.47 / $245.47 / $263.03
| Professional | | $245.47 | $245.47 | $263.03 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,630.27 / $6,760.83 / $12,882.50
| Facility | | $2,630.27 | $6,760.83 | $12,882.50 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $354.81 / $446.68 / $707.95
| Professional | | $354.81 | $446.68 | $707.95 |