- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $275.42 / $2,454.71 / $7,762.47
| Facility | | $275.42 | $2,454.71 | $7,762.47 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $117.49 / $281.84 / $645.65
| Professional | | $117.49 | $281.84 | $645.65 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,380.38 / $3,981.07 / $10,000.00
| Facility | | $1,380.38 | $3,981.07 | $10,000.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $134.90 / $257.04 / $524.81
| Professional | | $134.90 | $257.04 | $524.81 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $204.17 / $630.96 / $1,737.80
| Facility | | $204.17 | $630.96 | $1,737.80 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $134.90 / $295.12 / $630.96
| Professional | | $134.90 | $295.12 | $630.96 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $645.65 / $2,570.40 / $6,165.95
| Facility | | $645.65 | $2,570.40 | $6,165.95 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $114.82 / $251.19 / $501.19
| Professional | | $114.82 | $251.19 | $501.19 |