- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,288.25 / $3,890.45 / $9,772.37
| Facility | | $1,288.25 | $3,890.45 | $9,772.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $794.33 / $912.01 / $1,659.59
| Professional | | $794.33 | $912.01 | $1,659.59 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,918.31 / $10,964.78 / $17,782.79
| Facility | | $6,918.31 | $10,964.78 | $17,782.79 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $912.01 / $1,148.15 / $1,412.54
| Professional | | $912.01 | $1,148.15 | $1,412.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $489.78 / $1,318.26 / $7,585.78
| Facility | | $489.78 | $1,318.26 | $7,585.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $812.83 / $1,071.52 / $6,760.83
| Professional | | $812.83 | $1,071.52 | $6,760.83 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $346.74 / $1,949.84 / $6,165.95
| Facility | | $346.74 | $1,949.84 | $6,165.95 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $758.58 / $954.99 / $1,380.38
| Professional | | $758.58 | $954.99 | $1,380.38 |