- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $257.04 / $501.19 / $2,187.76
| Facility | | $257.04 | $501.19 | $2,187.76 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $114.82 / $162.18 / $354.81
| Professional | | $114.82 | $162.18 | $354.81 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $371.54 / $851.14 / $851.14
| Facility | | $371.54 | $851.14 | $851.14 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $407.38 / $501.19 / $831.76
| Professional | | $407.38 | $501.19 | $831.76 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $134.90 / $10,471.29 / $25,703.96
| Facility | | $134.90 | $10,471.29 | $25,703.96 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $151.36 / $151.36 / $380.19
| Professional | | $151.36 | $151.36 | $380.19 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $114.82 / $190.55 / $398.11
| Facility | | $114.82 | $190.55 | $398.11 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $81.28 / $114.82 / $269.15
| Professional | | $81.28 | $114.82 | $269.15 |