- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,000.00 / $4,365.16 / $11,220.18
| Facility | | $1,000.00 | $4,365.16 | $11,220.18 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $416.87 / $1,380.38 / $2,570.40
| Professional | | $416.87 | $1,380.38 | $2,570.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,548.13 / $7,762.47 / $16,595.87
| Facility | | $3,548.13 | $7,762.47 | $16,595.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $501.19 / $1,584.89 / $3,890.45
| Professional | | $501.19 | $1,584.89 | $3,890.45 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $724.44 / $4,570.88 / $15,135.61
| Facility | | $724.44 | $4,570.88 | $15,135.61 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $478.63 / $1,659.59 / $4,265.80
| Professional | | $478.63 | $1,659.59 | $4,265.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,511.89 / $7,244.36 / $15,848.93
| Facility | | $2,511.89 | $7,244.36 | $15,848.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $436.52 / $1,479.11 / $3,388.44
| Professional | | $436.52 | $1,479.11 | $3,388.44 |