- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $338.84 / $1,288.25 / $3,890.45
| Facility | | $338.84 | $1,288.25 | $3,890.45 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $45.71 / $95.50 / $151.36
| Professional | | $45.71 | $95.50 | $151.36 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $602.56 / $1,096.48 / $1,513.56
| Facility | | $602.56 | $1,096.48 | $1,513.56 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $52.48 / $93.33 / $131.83
| Professional | | $52.48 | $93.33 | $131.83 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $39.81 / $39.81 / $39.81
| Facility | | $39.81 | $39.81 | $39.81 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $51.29 / $100.00 / $173.78
| Professional | | $51.29 | $100.00 | $173.78 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $338.84 / $1,047.13 / $2,187.76
| Facility | | $338.84 | $1,047.13 | $2,187.76 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $47.86 / $100.00 / $177.83
| Professional | | $47.86 | $100.00 | $177.83 |