- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,122.02 / $5,495.41 / $12,882.50
| Facility | | $1,122.02 | $5,495.41 | $12,882.50 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $416.87 / $1,584.89 / $2,884.03
| Professional | | $416.87 | $1,584.89 | $2,884.03 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $173.78 / $234.42 / $323.59
| Professional | | $173.78 | $234.42 | $323.59 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $794.33 / $794.33 / $3,801.89
| Professional | | $794.33 | $794.33 | $3,801.89 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $501.19 / $1,737.80 / $3,801.89
| Professional | | $501.19 | $1,737.80 | $3,801.89 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $54.95 / $3,090.30 / $9,772.37
| Facility | | $54.95 | $3,090.30 | $9,772.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,949.84 / $3,311.31 / $15,848.93
| Professional | | $1,949.84 | $3,311.31 | $15,848.93 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,818.38 / $6,918.31 / $15,135.61
| Facility | | $2,818.38 | $6,918.31 | $15,135.61 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $501.19 / $1,862.09 / $3,630.78
| Professional | | $501.19 | $1,862.09 | $3,630.78 |