- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $257.04 / $2,570.40 / $6,760.83
| Facility | | $257.04 | $2,570.40 | $6,760.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $181.97 / $263.03 / $295.12
| Professional | | $181.97 | $263.03 | $295.12 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $288.40 / $371.54 / $630.96
| Professional | | $288.40 | $371.54 | $630.96 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $151.36 / $151.36 / $151.36
| Professional | | $151.36 | $151.36 | $151.36 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $263.03 / $9,332.54 / $33,113.11
| Facility | | $263.03 | $9,332.54 | $33,113.11 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $257.04 / $426.58 / $1,659.59
| Professional | | $257.04 | $426.58 | $1,659.59 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $288.40 / $371.54 / $630.96
| Professional | | $288.40 | $371.54 | $630.96 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,511.38 / $13,489.63 / $34,673.69
| Facility | | $8,511.38 | $13,489.63 | $34,673.69 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $245.47 / $389.05 / $741.31
| Professional | | $245.47 | $389.05 | $741.31 |