- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $354.81 / $3,019.95 / $8,317.64
| Facility | | $354.81 | $3,019.95 | $8,317.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $114.82 / $346.74 / $933.25
| Professional | | $114.82 | $346.74 | $933.25 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,819.70 / $5,011.87 / $10,964.78
| Facility | | $1,819.70 | $5,011.87 | $10,964.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $117.49 / $380.19 / $1,148.15
| Professional | | $117.49 | $380.19 | $1,148.15 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $218.78 / $1,202.26 / $2,818.38
| Facility | | $218.78 | $1,202.26 | $2,818.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $131.83 / $363.08 / $1,096.48
| Professional | | $131.83 | $363.08 | $1,096.48 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,000.00 / $2,884.03 / $6,309.57
| Facility | | $1,000.00 | $2,884.03 | $6,309.57 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $114.82 / $331.13 / $933.25
| Professional | | $114.82 | $331.13 | $933.25 |