- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $575.44 / $3,388.44 / $9,120.11
| Facility | | $575.44 | $3,388.44 | $9,120.11 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $269.15 / $426.58 / $870.96
| Professional | | $269.15 | $426.58 | $870.96 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,584.89 / $4,365.16 / $9,332.54
| Facility | | $1,584.89 | $4,365.16 | $9,332.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $275.42 / $457.09 / $912.01
| Professional | | $275.42 | $457.09 | $912.01 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $380.19 / $1,288.25 / $3,630.78
| Facility | | $380.19 | $1,288.25 | $3,630.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $316.23 / $537.03 / $1,174.90
| Professional | | $316.23 | $537.03 | $1,174.90 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $537.03 / $1,949.84 / $4,677.35
| Facility | | $537.03 | $1,949.84 | $4,677.35 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $269.15 / $446.68 / $851.14
| Professional | | $269.15 | $446.68 | $851.14 |