- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,000.00 / $4,897.79 / $11,481.54
| Facility | | $1,000.00 | $4,897.79 | $11,481.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $234.42 / $467.74 / $776.25
| Professional | | $234.42 | $467.74 | $776.25 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,691.53 / $5,248.07 / $15,135.61
| Facility | | $2,691.53 | $5,248.07 | $15,135.61 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $107.15 / $758.58 / $3,630.78
| Professional | | $107.15 | $758.58 | $3,630.78 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $416.87 / $416.87 / $4,677.35
| Facility | | $416.87 | $416.87 | $4,677.35 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $398.11 / $1,174.90 / $1,174.90
| Professional | | $398.11 | $1,174.90 | $1,174.90 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,398.83 / $7,079.46 / $15,488.17
| Facility | | $2,398.83 | $7,079.46 | $15,488.17 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $512.86 / $812.83 / $1,445.44
| Professional | | $512.86 | $812.83 | $1,445.44 |