- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,949.84 / $5,623.41 / $10,471.29
| Facility | | $1,949.84 | $5,623.41 | $10,471.29 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $102.33 / $151.36 / $204.17
| Professional | | $102.33 | $151.36 | $204.17 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $302.00 / $302.00 / $302.00
| Professional | | $302.00 | $302.00 | $302.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $138.04 / $2,187.76 / $8,709.64
| Facility | | $138.04 | $2,187.76 | $8,709.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $151.36 / $190.55 / $1,202.26
| Professional | | $151.36 | $190.55 | $1,202.26 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,819.70 / $3,715.35 / $8,912.51
| Facility | | $1,819.70 | $3,715.35 | $8,912.51 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $151.36 / $181.97 / $263.03
| Professional | | $151.36 | $181.97 | $263.03 |