- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $933.25 / $4,365.16 / $10,964.78
| Facility | | $933.25 | $4,365.16 | $10,964.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $446.68 / $562.34 / $1,318.26
| Professional | | $446.68 | $562.34 | $1,318.26 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,818.38 / $7,079.46 / $14,454.40
| Facility | | $2,818.38 | $7,079.46 | $14,454.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $389.05 / $588.84 / $1,230.27
| Professional | | $389.05 | $588.84 | $1,230.27 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $575.44 / $1,513.56 / $3,715.35
| Facility | | $575.44 | $1,513.56 | $3,715.35 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $457.09 / $724.44 / $1,621.81
| Professional | | $457.09 | $724.44 | $1,621.81 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,513.56 / $4,265.80 / $10,000.00
| Facility | | $1,513.56 | $4,265.80 | $10,000.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $389.05 / $562.34 / $1,122.02
| Professional | | $389.05 | $562.34 | $1,122.02 |