- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,691.53 / $5,623.41 / $10,964.78
| Facility | | $2,691.53 | $5,623.41 | $10,964.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $162.18 / $218.78 / $467.74
| Professional | | $162.18 | $218.78 | $467.74 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $186.21 / $288.40 / $645.65
| Professional | | $186.21 | $288.40 | $645.65 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $257.04 / $316.23 / $457.09
| Professional | | $257.04 | $316.23 | $457.09 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,606.93 / $10,232.93 / $16,218.10
| Facility | | $6,606.93 | $10,232.93 | $16,218.10 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $147.91 / $251.19 / $501.19
| Professional | | $147.91 | $251.19 | $501.19 |
- 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
- $173.78 / $245.47 / $416.87
| Professional | | $173.78 | $245.47 | $416.87 |