- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $407.38 / $2,398.83 / $12,302.69
| Facility | | $407.38 | $2,398.83 | $12,302.69 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $371.54 / $1,000.00 / $2,041.74
| Professional | | $371.54 | $1,000.00 | $2,041.74 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,467.37 / $4,677.35 / $6,309.57
| Facility | | $3,467.37 | $4,677.35 | $6,309.57 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $302.00 / $1,000.00 / $3,311.31
| Professional | | $302.00 | $1,000.00 | $3,311.31 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $691.83 / $2,238.72 / $4,570.88
| Professional | | $691.83 | $2,238.72 | $4,570.88 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,000.00 / $10,000.00 / $10,000.00
| Facility | | $10,000.00 | $10,000.00 | $10,000.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $363.08 / $1,548.82 / $3,715.35
| Professional | | $363.08 | $1,548.82 | $3,715.35 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,000.00 / $10,000.00 / $10,000.00
| Facility | | $10,000.00 | $10,000.00 | $10,000.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $512.86 / $1,949.84 / $5,370.32
| Professional | | $512.86 | $1,949.84 | $5,370.32 |