- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $338.84 / $2,818.38 / $8,511.38
| Facility | | $338.84 | $2,818.38 | $8,511.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $186.21 / $323.59 / $691.83
| Professional | | $186.21 | $323.59 | $691.83 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,584.89 / $4,365.16 / $9,549.93
| Facility | | $1,584.89 | $4,365.16 | $9,549.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $190.55 / $316.23 / $676.08
| Professional | | $190.55 | $316.23 | $676.08 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $323.59 / $1,023.29 / $2,884.03
| Facility | | $323.59 | $1,023.29 | $2,884.03 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $218.78 / $389.05 / $891.25
| Professional | | $218.78 | $389.05 | $891.25 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $316.23 / $1,202.26 / $3,548.13
| Facility | | $316.23 | $1,202.26 | $3,548.13 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $186.21 / $323.59 / $616.60
| Professional | | $186.21 | $323.59 | $616.60 |