- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,698.24 / $4,897.79 / $11,748.98
| Facility | | $1,698.24 | $4,897.79 | $11,748.98 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,122.02 / $2,570.40 / $3,715.35
| Professional | | $1,122.02 | $2,570.40 | $3,715.35 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,466.84 / $14,454.40 / $28,840.32
| Facility | | $4,466.84 | $14,454.40 | $28,840.32 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,884.03 / $3,890.45 / $7,413.10
| Professional | | $2,884.03 | $3,890.45 | $7,413.10 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $398.11 / $12,022.64 / $34,673.69
| Facility | | $398.11 | $12,022.64 | $34,673.69 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,290.87 / $4,677.35 / $14,125.38
| Professional | | $2,290.87 | $4,677.35 | $14,125.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $851.14 / $3,162.28 / $10,232.93
| Facility | | $851.14 | $3,162.28 | $10,232.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,584.89 / $2,570.40 / $5,623.41
| Professional | | $1,584.89 | $2,570.40 | $5,623.41 |