- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,047.13 / $4,466.84 / $10,964.78
| Facility | | $1,047.13 | $4,466.84 | $10,964.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $660.69 / $831.76 / $2,137.96
| Professional | | $660.69 | $831.76 | $2,137.96 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,235.94 / $8,709.64 / $17,782.79
| Facility | | $3,235.94 | $8,709.64 | $17,782.79 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $645.65 / $954.99 / $1,778.28
| Professional | | $645.65 | $954.99 | $1,778.28 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $977.24 / $2,089.30 / $5,128.61
| Facility | | $977.24 | $2,089.30 | $5,128.61 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $676.08 / $1,096.48 / $2,398.83
| Professional | | $676.08 | $1,096.48 | $2,398.83 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,511.89 / $7,244.36 / $16,218.10
| Facility | | $2,511.89 | $7,244.36 | $16,218.10 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $616.60 / $891.25 / $1,659.59
| Professional | | $616.60 | $891.25 | $1,659.59 |