- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,380.38 / $2,344.23 / $3,801.89
| Facility | | $1,380.38 | $2,344.23 | $3,801.89 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $147.91 / $794.33 / $9,772.37
| Professional | | $147.91 | $794.33 | $9,772.37 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $0.03 / $2,884.03 / $9,120.11
| Facility | | $0.03 | $2,884.03 | $9,120.11 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $83.18 / $3,630.78 / $9,772.37
| Facility | | $83.18 | $3,630.78 | $9,772.37 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,995.26 / $4,265.80 / $9,772.37
| Facility | | $1,995.26 | $4,265.80 | $9,772.37 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $0.03 / $3,801.89 / $9,120.11
| Facility | | $0.03 | $3,801.89 | $9,120.11 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,862.09 / $4,265.80 / $10,000.00
| Facility | | $1,862.09 | $4,265.80 | $10,000.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $53.70 / $53.70 / $53.70
| Professional | | $53.70 | $53.70 | $53.70 |