- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,148.15 / $4,897.79 / $11,481.54
| Facility | | $1,148.15 | $4,897.79 | $11,481.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $630.96 / $794.33 / $1,737.80
| Professional | | $630.96 | $794.33 | $1,737.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,754.23 / $7,762.47 / $14,791.08
| Facility | | $2,754.23 | $7,762.47 | $14,791.08 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $616.60 / $912.01 / $1,698.24
| Professional | | $616.60 | $912.01 | $1,698.24 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $707.95 / $1,584.89 / $4,897.79
| Facility | | $707.95 | $1,584.89 | $4,897.79 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $660.69 / $1,047.13 / $2,290.87
| Professional | | $660.69 | $1,047.13 | $2,290.87 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,513.56 / $4,265.80 / $9,549.93
| Facility | | $1,513.56 | $4,265.80 | $9,549.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $588.84 / $851.14 / $1,584.89
| Professional | | $588.84 | $851.14 | $1,584.89 |