- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $165.96 / $2,238.72 / $2,884.03
| Facility | | $165.96 | $2,238.72 | $2,884.03 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $158.49 / $446.68 / $3,715.35
| Professional | | $158.49 | $446.68 | $3,715.35 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,023.29 / $11,481.54 / $26,915.35
| Facility | | $1,023.29 | $11,481.54 | $26,915.35 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $316.23 / $1,096.48 / $8,511.38
| Professional | | $316.23 | $1,096.48 | $8,511.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,079.46 / $10,471.29 / $24,547.09
| Facility | | $7,079.46 | $10,471.29 | $24,547.09 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $380.19 / $4,466.84 / $11,481.54
| Professional | | $380.19 | $4,466.84 | $11,481.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,943.28 / $10,000.00 / $19,498.45
| Facility | | $7,943.28 | $10,000.00 | $19,498.45 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $371.54 / $3,715.35 / $10,000.00
| Professional | | $371.54 | $3,715.35 | $10,000.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $234.42 / $3,890.45 / $10,471.29
| Facility | | $234.42 | $3,890.45 | $10,471.29 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,454.71 / $6,456.54 / $19,952.62
| Professional | | $2,454.71 | $6,456.54 | $19,952.62 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,584.89 / $8,709.64 / $14,791.08
| Facility | | $1,584.89 | $8,709.64 | $14,791.08 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $257.04 / $3,162.28 / $10,471.29
| Professional | | $257.04 | $3,162.28 | $10,471.29 |