- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $204.17 / $5,495.41 / $10,471.29
| Facility | | $204.17 | $5,495.41 | $10,471.29 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $93.33 / $186.21 / $281.84
| Professional | | $93.33 | $186.21 | $281.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $234.42 / $234.42 / $234.42
| Professional | | $234.42 | $234.42 | $234.42 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $107.15 / $213.80 / $407.38
| Professional | | $107.15 | $213.80 | $407.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $100.00 / $223.87 / $446.68
| Facility | | $100.00 | $223.87 | $446.68 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $213.80 / $331.13 / $1,380.38
| Professional | | $213.80 | $331.13 | $1,380.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $64.57 / $79.43 / $186.21
| Facility | | $64.57 | $79.43 | $186.21 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $102.33 / $208.93 / $316.23
| Professional | | $102.33 | $208.93 | $316.23 |