- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,531.03 / $1,589.17 / $8,620.28
| Facility | | $1,531.03 | $1,589.17 | $8,620.28 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,356.61 / $1,550.41 / $1,938.01
| Professional | | $1,356.61 | $1,550.41 | $1,938.01 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $28.44 / $33.47 / $3,042.67
| Professional | | $28.44 | $33.47 | $3,042.67 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,325.61 / $25,436.38 / $48,837.85
| Facility | | $2,325.61 | $25,436.38 | $48,837.85 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,228.71 / $2,713.21 / $35,944.85
| Professional | | $2,228.71 | $2,713.21 | $35,944.85 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,259.71 / $1,507.97 / $2,557.21
| Facility | | $1,259.71 | $1,507.97 | $2,557.21 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,249.17 / $9,341.20 / $9,341.20
| Professional | | $2,249.17 | $9,341.20 | $9,341.20 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $45.00 / $100.00 / $100.00
| Professional | | $45.00 | $100.00 | $100.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $813.96 / $1,162.81 / $1,938.01
| Professional | | $813.96 | $1,162.81 | $1,938.01 |