- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,737.80 / $2,398.83 / $11,481.54
| Facility | | $1,737.80 | $2,398.83 | $11,481.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $354.81 / $416.87 / $758.58
| Professional | | $354.81 | $416.87 | $758.58 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,912.51 / $10,000.00 / $18,197.01
| Facility | | $8,912.51 | $10,000.00 | $18,197.01 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $338.84 / $724.44 / $1,071.52
| Professional | | $338.84 | $724.44 | $1,071.52 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,495.41 / $5,495.41 / $5,495.41
| Facility | | $5,495.41 | $5,495.41 | $5,495.41 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $323.59 / $645.65 / $1,071.52
| Professional | | $323.59 | $645.65 | $1,071.52 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,122.02 / $4,677.35 / $12,302.69
| Facility | | $1,122.02 | $4,677.35 | $12,302.69 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $389.05 / $562.34 / $891.25
| Professional | | $389.05 | $562.34 | $891.25 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,122.02 / $4,677.35 / $12,302.69
| Facility | | $1,122.02 | $4,677.35 | $12,302.69 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $380.19 / $616.60 / $1,071.52
| Professional | | $380.19 | $616.60 | $1,071.52 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $269.15 / $309.03 / $446.68
| Facility | | $269.15 | $309.03 | $446.68 |