- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $211.47 / $774.33 / $1,768.00
| Facility | | $211.47 | $774.33 | $1,768.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $77.56 / $156.65 / $370.21
| Professional | | $77.56 | $156.65 | $370.21 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $32.21 / $37.17 / $62.37
| Professional | | $32.21 | $37.17 | $62.37 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $895.23 / $1,086.41 / $1,461.57
| Facility | | $895.23 | $1,086.41 | $1,461.57 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $105.46 / $173.46 / $228.45
| Professional | | $105.46 | $173.46 | $228.45 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $85.33 / $176.40 / $402.00
| Professional | | $85.33 | $176.40 | $402.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $500.00 / $1,754.00 / $3,200.00
| Facility | | $500.00 | $1,754.00 | $3,200.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $128.30 / $175.76 / $281.22
| Professional | | $128.30 | $175.76 | $281.22 |