- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,187.76 / $5,754.40 / $10,471.29
| Facility | | $2,187.76 | $5,754.40 | $10,471.29 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $234.42 / $489.78 / $1,023.29
| Professional | | $234.42 | $489.78 | $1,023.29 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $251.19 / $537.03 / $1,288.25
| Professional | | $251.19 | $537.03 | $1,288.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $407.38 / $630.96 / $977.24
| Professional | | $407.38 | $630.96 | $977.24 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,265.80 / $6,606.93 / $10,471.29
| Facility | | $4,265.80 | $6,606.93 | $10,471.29 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $199.53 / $524.81 / $1,148.15
| Professional | | $199.53 | $524.81 | $1,148.15 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,951.21 / $6,606.93 / $10,964.78
| Facility | | $2,951.21 | $6,606.93 | $10,964.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $190.55 / $436.52 / $977.24
| Professional | | $190.55 | $436.52 | $977.24 |