- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $380.19 / $4,365.16 / $14,791.08
| Facility | | $380.19 | $4,365.16 | $14,791.08 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $213.80 / $309.03 / $416.87
| Professional | | $213.80 | $309.03 | $416.87 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,888.44 / $6,760.83 / $7,413.10
| Facility | | $5,888.44 | $6,760.83 | $7,413.10 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $380.19 / $537.03 / $954.99
| Professional | | $380.19 | $537.03 | $954.99 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $234.42 / $338.84 / $2,511.89
| Professional | | $234.42 | $338.84 | $2,511.89 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,698.24 / $1,698.24 / $1,698.24
| Facility | | $1,698.24 | $1,698.24 | $1,698.24 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,445.44 / $1,445.44 / $1,445.44
| Professional | | $1,445.44 | $1,445.44 | $1,445.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $295.12 / $354.81 / $436.52
| Professional | | $295.12 | $354.81 | $436.52 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $275.42 / $371.54 / $562.34
| Facility | | $275.42 | $371.54 | $562.34 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $275.42 / $524.81 / $10,000.00
| Facility | | $275.42 | $524.81 | $10,000.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $275.42 / $524.81 / $10,000.00
| Professional | | $275.42 | $524.81 | $10,000.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,623.41 / $9,549.93 / $19,054.61
| Facility | | $5,623.41 | $9,549.93 | $19,054.61 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $204.17 / $316.23 / $537.03
| Professional | | $204.17 | $316.23 | $537.03 |