- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $933.25 / $4,466.84 / $10,964.78
| Facility | | $933.25 | $4,466.84 | $10,964.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $501.19 / $602.56 / $1,548.82
| Professional | | $501.19 | $602.56 | $1,548.82 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,754.23 / $7,079.46 / $14,454.40
| Facility | | $2,754.23 | $7,079.46 | $14,454.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $489.78 / $741.31 / $1,412.54
| Professional | | $489.78 | $741.31 | $1,412.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $977.24 / $1,819.70 / $4,168.69
| Facility | | $977.24 | $1,819.70 | $4,168.69 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $549.54 / $831.76 / $1,778.28
| Professional | | $549.54 | $831.76 | $1,778.28 |
- 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
- $467.74 / $660.69 / $1,230.27
| Professional | | $467.74 | $660.69 | $1,230.27 |