- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,445.44 / $3,090.30 / $6,309.57
| Facility | | $1,445.44 | $3,090.30 | $6,309.57 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $177.83 / $1,258.93 / $2,951.21
| Professional | | $177.83 | $1,258.93 | $2,951.21 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $416.87 / $1,318.26 / $1,995.26
| Facility | | $416.87 | $1,318.26 | $1,995.26 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $144.54 / $691.83 / $2,884.03
| Professional | | $144.54 | $691.83 | $2,884.03 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $194.98 / $549.54 / $3,311.31
| Professional | | $194.98 | $549.54 | $3,311.31 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $181.97 / $1,412.54 / $2,691.53
| Facility | | $181.97 | $1,412.54 | $2,691.53 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,584.89 / $2,238.72 / $6,606.93
| Professional | | $1,584.89 | $2,238.72 | $6,606.93 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $676.08 / $1,230.27 / $2,187.76
| Facility | | $676.08 | $1,230.27 | $2,187.76 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $181.97 / $1,412.54 / $2,884.03
| Professional | | $181.97 | $1,412.54 | $2,884.03 |