- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $851.14 / $6,760.83 / $15,488.17
| Facility | | $851.14 | $6,760.83 | $15,488.17 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $630.96 / $758.58 / $1,698.24
| Professional | | $630.96 | $758.58 | $1,698.24 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,606.93 / $7,413.10 / $9,332.54
| Facility | | $6,606.93 | $7,413.10 | $9,332.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $645.65 / $870.96 / $1,230.27
| Professional | | $645.65 | $870.96 | $1,230.27 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $707.95 / $1,096.48 / $6,918.31
| Professional | | $707.95 | $1,096.48 | $6,918.31 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $575.44 / $794.33 / $1,445.44
| Professional | | $575.44 | $794.33 | $1,445.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $602.56 / $758.58 / $1,905.46
| Professional | | $602.56 | $758.58 | $1,905.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $645.65 / $933.25 / $1,621.81
| Professional | | $645.65 | $933.25 | $1,621.81 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $676.08 / $870.96 / $1,412.54
| Facility | | $676.08 | $870.96 | $1,412.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $549.54 / $851.14 / $10,000.00
| Facility | | $549.54 | $851.14 | $10,000.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $549.54 / $851.14 / $10,000.00
| Professional | | $549.54 | $851.14 | $10,000.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,760.83 / $11,481.54 / $23,988.33
| Facility | | $6,760.83 | $11,481.54 | $23,988.33 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $501.19 / $794.33 / $1,288.25
| Professional | | $501.19 | $794.33 | $1,288.25 |