- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $457.09 / $3,890.45 / $10,471.29
| Facility | | $457.09 | $3,890.45 | $10,471.29 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $234.42 / $363.08 / $741.31
| Professional | | $234.42 | $363.08 | $741.31 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,454.71 / $4,897.79 / $13,489.63
| Facility | | $2,454.71 | $4,897.79 | $13,489.63 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $199.53 / $371.54 / $676.08
| Professional | | $199.53 | $371.54 | $676.08 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $398.11 / $1,047.13 / $2,951.21
| Facility | | $398.11 | $1,047.13 | $2,951.21 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $269.15 / $457.09 / $977.24
| Professional | | $269.15 | $457.09 | $977.24 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,513.56 / $4,265.80 / $10,000.00
| Facility | | $1,513.56 | $4,265.80 | $10,000.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $229.09 / $380.19 / $724.44
| Professional | | $229.09 | $380.19 | $724.44 |