- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $354.63 / $2,000.00 / $2,058.42
| Facility | | $354.63 | $2,000.00 | $2,058.42 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $161.88 / $384.39 / $2,626.25
| Professional | | $161.88 | $384.39 | $2,626.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $906.73 / $6,252.85 / $9,476.03
| Professional | | $906.73 | $6,252.85 | $9,476.03 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $220.43 / $1,366.88 / $12,062.58
| Professional | | $220.43 | $1,366.88 | $12,062.58 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $209.69 / $732.31 / $6,434.75
| Facility | | $209.69 | $732.31 | $6,434.75 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $264.76 / $2,075.15 / $14,539.01
| Professional | | $264.76 | $2,075.15 | $14,539.01 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $346.22 / $3,574.86 / $6,064.93
| Professional | | $346.22 | $3,574.86 | $6,064.93 |