- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,202.26 / $6,025.60 / $9,332.54
| Facility | | $1,202.26 | $6,025.60 | $9,332.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $891.25 / $1,047.13 / $2,630.27
| Professional | | $891.25 | $1,047.13 | $2,630.27 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $575.44 / $1,202.26 / $2,089.30
| Professional | | $575.44 | $1,202.26 | $2,089.30 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $32.36 / $33.11 / $1,862.09
| Professional | | $32.36 | $33.11 | $1,862.09 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,317.64 / $10,000.00 / $22,387.21
| Facility | | $8,317.64 | $10,000.00 | $22,387.21 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,288.25 / $1,513.56 / $1,949.84
| Professional | | $1,288.25 | $1,513.56 | $1,949.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $933.25 / $1,778.28 / $2,398.83
| Professional | | $933.25 | $1,778.28 | $2,398.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,174.90 / $1,445.44 / $1,949.84
| Professional | | $1,174.90 | $1,445.44 | $1,949.84 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,884.03 / $5,128.61 / $13,803.84
| Facility | | $2,884.03 | $5,128.61 | $13,803.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $851.14 / $1,047.13 / $1,659.59
| Professional | | $851.14 | $1,047.13 | $1,659.59 |