- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,398.83 / $3,019.95 / $15,848.93
| Facility | | $2,398.83 | $3,019.95 | $15,848.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $724.44 / $812.83 / $2,344.23
| Professional | | $724.44 | $812.83 | $2,344.23 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,623.41 / $15,135.61 / $23,988.33
| Facility | | $5,623.41 | $15,135.61 | $23,988.33 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $724.44 / $1,445.44 / $2,089.30
| Professional | | $724.44 | $1,445.44 | $2,089.30 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $467.74 / $1,548.82 / $2,454.71
| Professional | | $467.74 | $1,548.82 | $2,454.71 |
- 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
- $812.83 / $1,318.26 / $2,238.72
| Professional | | $812.83 | $1,318.26 | $2,238.72 |
- 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
- $912.01 / $1,348.96 / $2,454.71
| Professional | | $912.01 | $1,348.96 | $2,454.71 |