- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $676.08 / $3,388.44 / $8,128.31
| Facility | | $676.08 | $3,388.44 | $8,128.31 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $275.42 / $588.84 / $1,949.84
| Professional | | $275.42 | $588.84 | $1,949.84 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,819.70 / $5,128.61 / $10,964.78
| Facility | | $1,819.70 | $5,128.61 | $10,964.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $275.42 / $478.63 / $954.99
| Professional | | $275.42 | $478.63 | $954.99 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $446.68 / $1,122.02 / $4,466.84
| Facility | | $446.68 | $1,122.02 | $4,466.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $316.23 / $630.96 / $1,412.54
| Professional | | $316.23 | $630.96 | $1,412.54 |
- 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
- $269.15 / $512.86 / $1,000.00
| Professional | | $269.15 | $512.86 | $1,000.00 |