- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $177.83 / $524.81 / $2,238.72
| Facility | | $177.83 | $524.81 | $2,238.72 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $8.71 / $467.74 / $2,238.72
| Professional | | $8.71 | $467.74 | $2,238.72 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $56.23 / $1,230.27 / $1,621.81
| Facility | | $56.23 | $1,230.27 | $1,621.81 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $0.02 / $0.02 / $1,096.48
| Professional | | $0.02 | $0.02 | $1,096.48 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $316.23 / $812.83 / $1,778.28
| Facility | | $316.23 | $812.83 | $1,778.28 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $100.00 / $100.00 / $549.54
| Professional | | $100.00 | $100.00 | $549.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $302.00 / $602.56 / $1,288.25
| Facility | | $302.00 | $602.56 | $1,288.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $47.86 / $91.20 / $851.14
| Professional | | $47.86 | $91.20 | $851.14 |