- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $331.13 / $2,187.76 / $7,762.47
| Facility | | $331.13 | $2,187.76 | $7,762.47 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $120.23 / $141.25 / $281.84
| Professional | | $120.23 | $141.25 | $281.84 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $575.44 / $1,548.82 / $2,951.21
| Facility | | $575.44 | $1,548.82 | $2,951.21 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,230.27 / $1,230.27 / $1,548.82
| Facility | | $1,230.27 | $1,230.27 | $1,548.82 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $131.83 / $190.55 / $295.12
| Professional | | $131.83 | $190.55 | $295.12 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $147.91 / $407.38 / $691.83
| Professional | | $147.91 | $407.38 | $691.83 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $100.00 / $100.00 / $100.00
| Facility | | $100.00 | $100.00 | $100.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $144.54 / $169.82 / $190.55
| Professional | | $144.54 | $169.82 | $190.55 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $32.36 / $33.11 / $177.83
| Professional | | $32.36 | $33.11 | $177.83 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $151.36 / $831.76 / $2,344.23
| Facility | | $151.36 | $831.76 | $2,344.23 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $125.89 / $177.83 / $281.84
| Professional | | $125.89 | $177.83 | $281.84 |