- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,290.87 / $5,888.44 / $10,964.78
| Facility | | $2,290.87 | $5,888.44 | $10,964.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $275.42 / $354.81 / $1,288.25
| Professional | | $275.42 | $354.81 | $1,288.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $288.40 / $489.78 / $1,202.26
| Professional | | $288.40 | $489.78 | $1,202.26 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $288.40 / $380.19 / $524.81
| Professional | | $288.40 | $380.19 | $524.81 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,981.07 / $6,309.57 / $10,000.00
| Facility | | $3,981.07 | $6,309.57 | $10,000.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $288.40 / $426.58 / $1,258.93
| Professional | | $288.40 | $426.58 | $1,258.93 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,951.21 / $6,606.93 / $10,964.78
| Facility | | $2,951.21 | $6,606.93 | $10,964.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $204.17 / $371.54 / $741.31
| Professional | | $204.17 | $371.54 | $741.31 |