- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,348.96 / $5,248.07 / $12,589.25
| Facility | | $1,348.96 | $5,248.07 | $12,589.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,000.00 / $1,148.15 / $2,511.89
| Professional | | $1,000.00 | $1,148.15 | $2,511.89 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,235.94 / $8,511.38 / $16,218.10
| Facility | | $3,235.94 | $8,511.38 | $16,218.10 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $954.99 / $1,380.38 / $2,691.53
| Professional | | $954.99 | $1,380.38 | $2,691.53 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $398.11 / $2,238.72 / $7,943.28
| Facility | | $398.11 | $2,238.72 | $7,943.28 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,071.52 / $1,621.81 / $3,388.44
| Professional | | $1,071.52 | $1,621.81 | $3,388.44 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,884.03 / $8,912.51 / $20,892.96
| Facility | | $2,884.03 | $8,912.51 | $20,892.96 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $912.01 / $1,288.25 / $2,398.83
| Professional | | $912.01 | $1,288.25 | $2,398.83 |