- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $221.56 / $2,170.36 / $8,907.71
| Facility | | $221.56 | $2,170.36 | $8,907.71 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $216.45 / $507.11 / $3,046.73
| Professional | | $216.45 | $507.11 | $3,046.73 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,092.08 / $3,092.08 / $3,137.19
| Facility | | $3,092.08 | $3,092.08 | $3,137.19 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $212.22 / $351.23 / $2,899.81
| Professional | | $212.22 | $351.23 | $2,899.81 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $606.10 / $606.10 / $10,045.77
| Facility | | $606.10 | $606.10 | $10,045.77 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $171.76 / $392.02 / $3,274.83
| Professional | | $171.76 | $392.02 | $3,274.83 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $227.00 / $325.55 / $2,531.05
| Facility | | $227.00 | $325.55 | $2,531.05 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $257.07 / $261.00 / $2,639.00
| Professional | | $257.07 | $261.00 | $2,639.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3.00 / $533.00 / $2,768.50
| Professional | | $3.00 | $533.00 | $2,768.50 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,015.00 / $15,545.00 / $22,780.00
| Facility | | $4,015.00 | $15,545.00 | $22,780.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $204.92 / $1,464.76 / $3,759.25
| Professional | | $204.92 | $1,464.76 | $3,759.25 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,747.25 / $3,747.25 / $15,000.00
| Facility | | $3,747.25 | $3,747.25 | $15,000.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $7,619.80 / $14,708.64 / $17,318.93
| Professional | | $7,619.80 | $14,708.64 | $17,318.93 |