- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $478.63 / $3,235.94 / $8,709.64
| Facility | | $478.63 | $3,235.94 | $8,709.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $275.42 / $416.87 / $870.96
| Professional | | $275.42 | $416.87 | $870.96 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,089.30 / $5,248.07 / $11,220.18
| Facility | | $2,089.30 | $5,248.07 | $11,220.18 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $245.47 / $389.05 / $758.58
| Professional | | $245.47 | $389.05 | $758.58 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $407.38 / $1,122.02 / $3,162.28
| Facility | | $407.38 | $1,122.02 | $3,162.28 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $309.03 / $489.78 / $1,096.48
| Professional | | $309.03 | $489.78 | $1,096.48 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,000.00 / $2,951.21 / $6,918.31
| Facility | | $1,000.00 | $2,951.21 | $6,918.31 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $263.03 / $407.38 / $776.25
| Professional | | $263.03 | $407.38 | $776.25 |