- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $660.69 / $3,235.94 / $10,000.00
| Facility | | $660.69 | $3,235.94 | $10,000.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $269.15 / $933.25 / $1,905.46
| Professional | | $269.15 | $933.25 | $1,905.46 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,311.31 / $7,413.10 / $13,803.84
| Facility | | $3,311.31 | $7,413.10 | $13,803.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $288.40 / $912.01 / $2,290.87
| Professional | | $288.40 | $912.01 | $2,290.87 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $251.19 / $3,090.30 / $9,332.54
| Facility | | $251.19 | $3,090.30 | $9,332.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $295.12 / $870.96 / $2,454.71
| Professional | | $295.12 | $870.96 | $2,454.71 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $275.42 / $1,174.90 / $3,630.78
| Facility | | $275.42 | $1,174.90 | $3,630.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $275.42 / $870.96 / $2,137.96
| Professional | | $275.42 | $870.96 | $2,137.96 |