- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $575.44 / $3,981.07 / $6,456.54
| Facility | | $575.44 | $3,981.07 | $6,456.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $309.03 / $467.74 / $812.83
| Professional | | $309.03 | $467.74 | $812.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $275.42 / $346.74 / $3,311.31
| Professional | | $275.42 | $346.74 | $3,311.31 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $302.00 / $478.63 / $1,318.26
| Professional | | $302.00 | $478.63 | $1,318.26 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $524.81 / $616.60 / $1,122.02
| Professional | | $524.81 | $616.60 | $1,122.02 |
- 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
- $269.15 / $446.68 / $912.01
| Professional | | $269.15 | $446.68 | $912.01 |