- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $199.53 / $1,819.70 / $9,772.37
| Facility | | $199.53 | $1,819.70 | $9,772.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $47.86 / $117.49 / $218.78
| Professional | | $47.86 | $117.49 | $218.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $64.57 / $128.82 / $275.42
| Professional | | $64.57 | $128.82 | $275.42 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $64.57 / $141.25 / $371.54
| Professional | | $64.57 | $141.25 | $371.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,388.44 / $3,388.44 / $7,413.10
| Facility | | $3,388.44 | $3,388.44 | $7,413.10 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $56.23 / $144.54 / $309.03
| Professional | | $56.23 | $144.54 | $309.03 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,388.44 / $3,388.44 / $7,413.10
| Facility | | $3,388.44 | $3,388.44 | $7,413.10 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $57.54 / $147.91 / $323.59
| Professional | | $57.54 | $147.91 | $323.59 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $100.00 / $100.00 / $100.00
| Facility | | $100.00 | $100.00 | $100.00 |