- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,258.93 / $3,311.31 / $6,760.83
| Facility | | $1,258.93 | $3,311.31 | $6,760.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,000.00 / $1,288.25 / $1,905.46
| Professional | | $1,000.00 | $1,288.25 | $1,905.46 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $316.23 / $1,995.26 / $4,570.88
| Facility | | $316.23 | $1,995.26 | $4,570.88 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $501.19 / $1,258.93 / $2,570.40
| Professional | | $501.19 | $1,258.93 | $2,570.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $371.54 / $1,584.89 / $4,897.79
| Facility | | $371.54 | $1,584.89 | $4,897.79 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $257.04 / $676.08 / $3,162.28
| Professional | | $257.04 | $676.08 | $3,162.28 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,096.48 / $2,041.74 / $4,466.84
| Facility | | $1,096.48 | $2,041.74 | $4,466.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $691.83 / $1,479.11 / $3,090.30
| Professional | | $691.83 | $1,479.11 | $3,090.30 |