- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $360.93 / $2,161.00 / $7,879.32
| Facility | | $360.93 | $2,161.00 | $7,879.32 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $282.01 / $416.72 / $629.42
| Professional | | $282.01 | $416.72 | $629.42 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,114.00 / $4,050.00 / $8,281.00
| Facility | | $2,114.00 | $4,050.00 | $8,281.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $280.80 / $403.85 / $766.27
| Professional | | $280.80 | $403.85 | $766.27 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $477.31 / $510.73 / $908.00
| Facility | | $477.31 | $510.73 | $908.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $291.77 / $467.69 / $895.21
| Professional | | $291.77 | $467.69 | $895.21 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,757.50 / $5,605.50 / $11,732.00
| Facility | | $1,757.50 | $5,605.50 | $11,732.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $364.08 / $521.15 / $972.70
| Professional | | $364.08 | $521.15 | $972.70 |