- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $278.01 / $1,520.00 / $4,050.00
| Facility | | $278.01 | $1,520.00 | $4,050.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $159.05 / $218.85 / $370.54
| Professional | | $159.05 | $218.85 | $370.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,286.66 / $3,958.39 / $5,831.72
| Facility | | $2,286.66 | $3,958.39 | $5,831.72 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $197.67 / $273.52 / $316.24
| Professional | | $197.67 | $273.52 | $316.24 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,176.78 / $2,176.78 / $2,176.78
| Facility | | $2,176.78 | $2,176.78 | $2,176.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $173.19 / $268.27 / $430.64
| Professional | | $173.19 | $268.27 | $430.64 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $746.00 / $2,415.00 / $6,585.00
| Facility | | $746.00 | $2,415.00 | $6,585.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $202.86 / $250.28 / $393.05
| Professional | | $202.86 | $250.28 | $393.05 |