- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $575.44 / $5,011.87 / $18,197.01
| Facility | | $575.44 | $5,011.87 | $18,197.01 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $83.18 / $213.80 / $8,128.31
| Professional | | $83.18 | $213.80 | $8,128.31 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,168.69 / $9,120.11 / $28,840.32
| Facility | | $4,168.69 | $9,120.11 | $28,840.32 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $91.20 / $4,073.80 / $10,000.00
| Professional | | $91.20 | $4,073.80 | $10,000.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $147.91 / $12,882.50 / $33,884.42
| Facility | | $147.91 | $12,882.50 | $33,884.42 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $102.33 / $489.78 / $11,748.98
| Professional | | $102.33 | $489.78 | $11,748.98 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,630.78 / $11,220.18 / $26,302.68
| Facility | | $3,630.78 | $11,220.18 | $26,302.68 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $93.33 / $3,890.45 / $9,549.93
| Professional | | $93.33 | $3,890.45 | $9,549.93 |