- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $575.44 / $3,162.28 / $9,120.11
| Facility | | $575.44 | $3,162.28 | $9,120.11 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $208.93 / $269.15 / $467.74
| Professional | | $208.93 | $269.15 | $467.74 |
- 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
- $208.93 / $295.12 / $512.86
| Professional | | $208.93 | $295.12 | $512.86 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $389.05 / $676.08 / $1,621.81
| Facility | | $389.05 | $676.08 | $1,621.81 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $218.78 / $338.84 / $724.44
| Professional | | $218.78 | $338.84 | $724.44 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $660.69 / $2,570.40 / $6,165.95
| Facility | | $660.69 | $2,570.40 | $6,165.95 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $194.98 / $281.84 / $489.78
| Professional | | $194.98 | $281.84 | $489.78 |