- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $219.44 / $2,116.67 / $6,907.00
| Facility | | $219.44 | $2,116.67 | $6,907.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $121.12 / $202.65 / $365.89
| Professional | | $121.12 | $202.65 | $365.89 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,905.00 / $3,931.00 / $8,240.00
| Facility | | $1,905.00 | $3,931.00 | $8,240.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $137.52 / $230.88 / $344.74
| Professional | | $137.52 | $230.88 | $344.74 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $203.95 / $208.61 / $308.09
| Facility | | $203.95 | $208.61 | $308.09 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $134.87 / $232.55 / $426.24
| Professional | | $134.87 | $232.55 | $426.24 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,527.00 / $2,665.00 / $5,510.00
| Facility | | $1,527.00 | $2,665.00 | $5,510.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $194.88 / $277.76 / $504.09
| Professional | | $194.88 | $277.76 | $504.09 |