- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $554.46 / $940.17 / $1,779.08
| Facility | | $554.46 | $940.17 | $1,779.08 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $140.97 / $140.97 / $176.21
| Professional | | $140.97 | $140.97 | $176.21 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $109.93 / $1,446.42 / $2,617.54
| Facility | | $109.93 | $1,446.42 | $2,617.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $93.44 / $109.93 / $148.40
| Professional | | $93.44 | $109.93 | $148.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $482.14 / $626.78 / $771.42
| Facility | | $482.14 | $626.78 | $771.42 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $482.14 / $578.57 / $723.21
| Professional | | $482.14 | $578.57 | $723.21 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $313.39 / $911.52 / $1,879.73
| Facility | | $313.39 | $911.52 | $1,879.73 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $145.11 / $587.50 / $703.89
| Professional | | $145.11 | $587.50 | $703.89 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $87.07 / $124.39 / $227.83
| Professional | | $87.07 | $124.39 | $227.83 |