- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $173.99 / $2,678.00 / $6,915.00
| Facility | | $173.99 | $2,678.00 | $6,915.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $104.97 / $175.83 / $288.17
| Professional | | $104.97 | $175.83 | $288.17 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $996.37 / $2,722.51 / $5,292.58
| Facility | | $996.37 | $2,722.51 | $5,292.58 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $122.26 / $198.64 / $365.25
| Professional | | $122.26 | $198.64 | $365.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $101.12 / $181.02 / $372.71
| Professional | | $101.12 | $181.02 | $372.71 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $133.16 / $211.56 / $249.16
| Professional | | $133.16 | $211.56 | $249.16 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $132.04 / $206.40 / $315.14
| Professional | | $132.04 | $206.40 | $315.14 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $772.00 / $2,360.00 / $4,066.00
| Facility | | $772.00 | $2,360.00 | $4,066.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $165.48 / $229.99 / $440.49
| Professional | | $165.48 | $229.99 | $440.49 |