- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,380.38 / $4,570.88 / $11,220.18
| Facility | | $1,380.38 | $4,570.88 | $11,220.18 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,174.90 / $1,445.44 / $2,884.03
| Professional | | $1,174.90 | $1,445.44 | $2,884.03 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,890.45 / $9,772.37 / $17,782.79
| Facility | | $3,890.45 | $9,772.37 | $17,782.79 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,148.15 / $1,737.80 / $3,311.31
| Professional | | $1,148.15 | $1,737.80 | $3,311.31 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $323.59 / $3,467.37 / $9,549.93
| Facility | | $323.59 | $3,467.37 | $9,549.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,258.93 / $2,041.74 / $3,981.07
| Professional | | $1,258.93 | $2,041.74 | $3,981.07 |
- 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
- $1,148.15 / $1,659.59 / $3,019.95
| Professional | | $1,148.15 | $1,659.59 | $3,019.95 |