- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,737.80 / $5,370.32 / $11,748.98
| Facility | | $1,737.80 | $5,370.32 | $11,748.98 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $251.19 / $2,290.87 / $11,748.98
| Professional | | $251.19 | $2,290.87 | $11,748.98 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,548.82 / $5,128.61 / $15,135.61
| Facility | | $1,548.82 | $5,128.61 | $15,135.61 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $0.02 / $0.02 / $60.26
| Professional | | $0.02 | $0.02 | $60.26 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $34.67 / $446.68 / $1,000.00
| Facility | | $34.67 | $446.68 | $1,000.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $20.89 / $177.83 / $1,096.48
| Professional | | $20.89 | $177.83 | $1,096.48 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $229.09 / $1,071.52 / $3,467.37
| Facility | | $229.09 | $1,071.52 | $3,467.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $39.81 / $120.23 / $144.54
| Professional | | $39.81 | $120.23 | $144.54 |