- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,240.00 / $8,617.00 / $10,455.00
| Facility | | $2,240.00 | $8,617.00 | $10,455.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,674.50 / $1,802.81 / $2,028.65
| Professional | | $1,674.50 | $1,802.81 | $2,028.65 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,556.00 / $9,098.00 / $26,840.19
| Facility | | $6,556.00 | $9,098.00 | $26,840.19 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $51.17 / $137.22 / $211.03
| Professional | | $51.17 | $137.22 | $211.03 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,708.00 / $15,934.00 / $33,345.00
| Facility | | $3,708.00 | $15,934.00 | $33,345.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,061.00 / $2,606.00 / $6,471.00
| Facility | | $1,061.00 | $2,606.00 | $6,471.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,897.36 / $2,362.48 / $3,451.66
| Professional | | $1,897.36 | $2,362.48 | $3,451.66 |