- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,890.45 / $11,748.98 / $16,595.87
| Facility | | $3,890.45 | $11,748.98 | $16,595.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $380.19 / $489.78 / $2,041.74
| Professional | | $380.19 | $489.78 | $2,041.74 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,258.93 / $1,258.93 / $1,258.93
| Professional | | $1,258.93 | $1,258.93 | $1,258.93 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $436.52 / $602.56 / $11,748.98
| Facility | | $436.52 | $602.56 | $11,748.98 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $512.86 / $1,122.02 / $2,511.89
| Professional | | $512.86 | $1,122.02 | $2,511.89 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,380.38 / $1,479.11 / $2,089.30
| Professional | | $1,380.38 | $1,479.11 | $2,089.30 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $549.54 / $2,041.74 / $2,951.21
| Facility | | $549.54 | $2,041.74 | $2,951.21 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $60.26 / $363.08 / $1,258.93
| Professional | | $60.26 | $363.08 | $1,258.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $512.86 / $1,071.52 / $2,630.27
| Professional | | $512.86 | $1,071.52 | $2,630.27 |