- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,047.13 / $4,897.79 / $12,022.64
| Facility | | $1,047.13 | $4,897.79 | $12,022.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $316.23 / $1,380.38 / $2,454.71
| Professional | | $316.23 | $1,380.38 | $2,454.71 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,388.44 / $9,332.54 / $17,782.79
| Facility | | $3,388.44 | $9,332.54 | $17,782.79 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $389.05 / $1,659.59 / $4,073.80
| Professional | | $389.05 | $1,659.59 | $4,073.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $416.87 / $4,466.84 / $15,135.61
| Facility | | $416.87 | $4,466.84 | $15,135.61 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $380.19 / $1,548.82 / $4,466.84
| Professional | | $380.19 | $1,548.82 | $4,466.84 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,511.89 / $7,079.46 / $16,218.10
| Facility | | $2,511.89 | $7,079.46 | $16,218.10 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $346.74 / $1,445.44 / $3,467.37
| Professional | | $346.74 | $1,445.44 | $3,467.37 |