- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $524.81 / $3,162.28 / $9,120.11
| Facility | | $524.81 | $3,162.28 | $9,120.11 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $138.04 / $169.82 / $389.05
| Professional | | $138.04 | $169.82 | $389.05 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,584.89 / $4,168.69 / $10,000.00
| Facility | | $1,584.89 | $4,168.69 | $10,000.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $128.82 / $208.93 / $416.87
| Professional | | $128.82 | $208.93 | $416.87 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $218.78 / $467.74 / $1,318.26
| Facility | | $218.78 | $467.74 | $1,318.26 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $151.36 / $234.42 / $501.19
| Professional | | $151.36 | $234.42 | $501.19 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,513.56 / $4,265.80 / $9,549.93
| Facility | | $1,513.56 | $4,265.80 | $9,549.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $131.83 / $190.55 / $354.81
| Professional | | $131.83 | $190.55 | $354.81 |