- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $812.83 / $3,715.35 / $9,772.37
| Facility | | $812.83 | $3,715.35 | $9,772.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $380.19 / $446.68 / $1,071.52
| Professional | | $380.19 | $446.68 | $1,071.52 |
- 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
- $389.05 / $575.44 / $1,096.48
| Professional | | $389.05 | $575.44 | $1,096.48 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $724.44 / $1,318.26 / $3,019.95
| Facility | | $724.44 | $1,318.26 | $3,019.95 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $416.87 / $645.65 / $1,348.96
| Professional | | $416.87 | $645.65 | $1,348.96 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,000.00 / $2,884.03 / $6,456.54
| Facility | | $1,000.00 | $2,884.03 | $6,456.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $363.08 / $524.81 / $954.99
| Professional | | $363.08 | $524.81 | $954.99 |