- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $467.74 / $5,011.87 / $9,772.37
| Facility | | $467.74 | $5,011.87 | $9,772.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $208.93 / $323.59 / $467.74
| Professional | | $208.93 | $323.59 | $467.74 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $186.21 / $239.88 / $5,623.41
| Professional | | $186.21 | $239.88 | $5,623.41 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $204.17 / $346.74 / $1,000.00
| Professional | | $204.17 | $346.74 | $1,000.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $363.08 / $426.58 / $691.83
| Professional | | $363.08 | $426.58 | $691.83 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,819.70 / $10,000.00 / $26,302.68
| Facility | | $1,819.70 | $10,000.00 | $26,302.68 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $181.97 / $316.23 / $616.60
| Professional | | $181.97 | $316.23 | $616.60 |