- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $741.31 / $2,818.38 / $8,317.64
| Facility | | $741.31 | $2,818.38 | $8,317.64 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,041.74 / $2,398.83 / $2,691.53
| Facility | | $2,041.74 | $2,398.83 | $2,691.53 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $501.19 / $1,258.93 / $2,290.87
| Facility | | $501.19 | $1,258.93 | $2,290.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,047.13 / $1,047.13 / $1,047.13
| Professional | | $1,047.13 | $1,047.13 | $1,047.13 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $691.83 / $891.25 / $1,445.44
| Facility | | $691.83 | $891.25 | $1,445.44 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,148.15 / $5,128.61 / $14,125.38
| Facility | | $1,148.15 | $5,128.61 | $14,125.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,943.28 / $7,943.28 / $45,708.82
| Facility | | $7,943.28 | $7,943.28 | $45,708.82 |