- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $511.30 / $2,600.50 / $7,158.02
| Facility | | $511.30 | $2,600.50 | $7,158.02 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $195.71 / $452.59 / $3,237.35
| Professional | | $195.71 | $452.59 | $3,237.35 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,977.00 / $13,163.00 / $36,331.00
| Facility | | $4,977.00 | $13,163.00 | $36,331.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $208.25 / $454.79 / $903.70
| Professional | | $208.25 | $454.79 | $903.70 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $770.04 / $6,630.73 / $10,047.00
| Facility | | $770.04 | $6,630.73 | $10,047.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $220.21 / $539.70 / $4,552.83
| Professional | | $220.21 | $539.70 | $4,552.83 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,028.00 / $8,220.00 / $17,649.00
| Facility | | $3,028.00 | $8,220.00 | $17,649.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $220.62 / $1,873.15 / $4,442.46
| Professional | | $220.62 | $1,873.15 | $4,442.46 |