- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,020.53 / $3,500.00 / $7,000.00
| Facility | | $1,020.53 | $3,500.00 | $7,000.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $953.64 / $1,020.53 / $1,510.07
| Professional | | $953.64 | $1,020.53 | $1,510.07 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11,040.00 / $36,076.04 / $47,628.00
| Facility | | $11,040.00 | $36,076.04 | $47,628.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $42.32 / $137.63 / $161.91
| Professional | | $42.32 | $137.63 | $161.91 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,152.00 / $18,414.99 / $43,749.56
| Facility | | $1,152.00 | $18,414.99 | $43,749.56 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $16,100.00 / $16,100.00 / $16,100.00
| Facility | | $16,100.00 | $16,100.00 | $16,100.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1.12 / $1.32 / $1.32
| Professional | | $1.12 | $1.32 | $1.32 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,403.00 / $5,242.00 / $10,843.00
| Facility | | $1,403.00 | $5,242.00 | $10,843.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,712.69 / $2,263.60 / $3,663.75
| Professional | | $1,712.69 | $2,263.60 | $3,663.75 |