- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,096.48 / $3,890.45 / $9,772.37
| Facility | | $1,096.48 | $3,890.45 | $9,772.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $81.28 / $1,000.00 / $2,951.21
| Professional | | $81.28 | $1,000.00 | $2,951.21 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,819.70 / $5,370.32 / $12,302.69
| Facility | | $1,819.70 | $5,370.32 | $12,302.69 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $97.72 / $213.80 / $3,630.78
| Professional | | $97.72 | $213.80 | $3,630.78 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $162.18 / $11,220.18 / $28,183.83
| Facility | | $162.18 | $11,220.18 | $28,183.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $104.71 / $3,311.31 / $4,265.80
| Professional | | $104.71 | $3,311.31 | $4,265.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $316.23 / $1,318.26 / $4,786.30
| Facility | | $316.23 | $1,318.26 | $4,786.30 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $89.13 / $1,348.96 / $3,715.35
| Professional | | $89.13 | $1,348.96 | $3,715.35 |