- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $851.14 / $2,818.38 / $10,471.29
| Facility | | $851.14 | $2,818.38 | $10,471.29 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $776.25 / $912.01 / $1,778.28
| Professional | | $776.25 | $912.01 | $1,778.28 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,244.36 / $10,715.19 / $11,220.18
| Facility | | $7,244.36 | $10,715.19 | $11,220.18 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $758.58 / $912.01 / $1,584.89
| Professional | | $758.58 | $912.01 | $1,584.89 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $831.76 / $1,096.48 / $1,412.54
| Facility | | $831.76 | $1,096.48 | $1,412.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $891.25 / $1,096.48 / $1,348.96
| Professional | | $891.25 | $1,096.48 | $1,348.96 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $34.67 / $1,479.11 / $1,479.11
| Facility | | $34.67 | $1,479.11 | $1,479.11 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,000.00 / $1,584.89 / $7,079.46
| Professional | | $1,000.00 | $1,584.89 | $7,079.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $32.36 / $33.11 / $812.83
| Professional | | $32.36 | $33.11 | $812.83 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $851.14 / $4,677.35 / $10,000.00
| Facility | | $851.14 | $4,677.35 | $10,000.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $758.58 / $1,122.02 / $1,737.80
| Professional | | $758.58 | $1,122.02 | $1,737.80 |