- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,568.03 / $9,758.93 / $10,667.44
| Facility | | $4,568.03 | $9,758.93 | $10,667.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $328.73 / $602.69 / $2,427.50
| Professional | | $328.73 | $602.69 | $2,427.50 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $418.60 / $734.37 / $2,384.39
| Professional | | $418.60 | $734.37 | $2,384.39 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $441.42 / $1,289.98 / $3,447.05
| Professional | | $441.42 | $1,289.98 | $3,447.05 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $375.48 / $741.86 / $2,328.77
| Professional | | $375.48 | $741.86 | $2,328.77 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,568.03 / $9,758.93 / $10,667.44
| Facility | | $4,568.03 | $9,758.93 | $10,667.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $335.95 / $602.69 / $2,427.50
| Professional | | $335.95 | $602.69 | $2,427.50 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,782.83 / $2,243.03 / $2,835.75
| Professional | | $1,782.83 | $2,243.03 | $2,835.75 |