- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,071.52 / $4,570.88 / $11,481.54
| Facility | | $1,071.52 | $4,570.88 | $11,481.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $870.96 / $1,023.29 / $2,238.72
| Professional | | $870.96 | $1,023.29 | $2,238.72 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,548.13 / $9,120.11 / $16,982.44
| Facility | | $3,548.13 | $9,120.11 | $16,982.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $831.76 / $1,258.93 / $2,290.87
| Professional | | $831.76 | $1,258.93 | $2,290.87 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $323.59 / $2,754.23 / $7,943.28
| Facility | | $323.59 | $2,754.23 | $7,943.28 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $891.25 / $1,412.54 / $3,019.95
| Professional | | $891.25 | $1,412.54 | $3,019.95 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $851.14 / $3,162.28 / $10,232.93
| Facility | | $851.14 | $3,162.28 | $10,232.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $812.83 / $1,148.15 / $2,137.96
| Professional | | $812.83 | $1,148.15 | $2,137.96 |