- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $181.97 / $3,548.13 / $7,413.10
| Facility | | $181.97 | $3,548.13 | $7,413.10 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $102.33 / $169.82 / $309.03
| Professional | | $102.33 | $169.82 | $309.03 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $120.23 / $120.23 / $120.23
| Professional | | $120.23 | $120.23 | $120.23 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $794.33 / $2,238.72 / $3,548.13
| Facility | | $794.33 | $2,238.72 | $3,548.13 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $107.15 / $169.82 / $309.03
| Professional | | $107.15 | $169.82 | $309.03 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $102.33 / $177.83 / $371.54
| Professional | | $102.33 | $177.83 | $371.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $123.03 / $223.87 / $281.84
| Professional | | $123.03 | $223.87 | $281.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $154.88 / $245.47 / $281.84
| Professional | | $154.88 | $245.47 | $281.84 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $549.54 / $2,238.72 / $3,467.37
| Facility | | $549.54 | $2,238.72 | $3,467.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $120.23 / $204.17 / $371.54
| Professional | | $120.23 | $204.17 | $371.54 |