- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $912.01 / $3,715.35 / $9,772.37
| Facility | | $912.01 | $3,715.35 | $9,772.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $436.52 / $524.81 / $1,202.26
| Professional | | $436.52 | $524.81 | $1,202.26 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,621.81 / $4,265.80 / $10,000.00
| Facility | | $1,621.81 | $4,265.80 | $10,000.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $371.54 / $575.44 / $1,202.26
| Professional | | $371.54 | $575.44 | $1,202.26 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $575.44 / $1,288.25 / $3,630.78
| Facility | | $575.44 | $1,288.25 | $3,630.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $436.52 / $691.83 / $1,584.89
| Professional | | $436.52 | $691.83 | $1,584.89 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,000.00 / $2,884.03 / $6,456.54
| Facility | | $1,000.00 | $2,884.03 | $6,456.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $380.19 / $549.54 / $1,096.48
| Professional | | $380.19 | $549.54 | $1,096.48 |