- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,398.83 / $3,981.07 / $11,481.54
| Facility | | $2,398.83 | $3,981.07 | $11,481.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $851.14 / $1,047.13 / $3,090.30
| Professional | | $851.14 | $1,047.13 | $3,090.30 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,584.89 / $1,737.80 / $3,019.95
| Facility | | $1,584.89 | $1,737.80 | $3,019.95 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $831.76 / $1,949.84 / $2,818.38
| Professional | | $831.76 | $1,949.84 | $2,818.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $234.42 / $1,778.28 / $3,162.28
| Professional | | $234.42 | $1,778.28 | $3,162.28 |
- 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
- $954.99 / $1,548.82 / $2,630.27
| Professional | | $954.99 | $1,548.82 | $2,630.27 |
- 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
- $1,096.48 / $1,584.89 / $3,162.28
| Professional | | $1,096.48 | $1,584.89 | $3,162.28 |