- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $501.19 / $3,715.35 / $10,715.19
| Facility | | $501.19 | $3,715.35 | $10,715.19 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $323.59 / $446.68 / $933.25
| Professional | | $323.59 | $446.68 | $933.25 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,621.81 / $4,365.16 / $10,232.93
| Facility | | $1,621.81 | $4,365.16 | $10,232.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $346.74 / $537.03 / $1,047.13
| Professional | | $346.74 | $537.03 | $1,047.13 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $309.03 / $1,479.11 / $4,365.16
| Facility | | $309.03 | $1,479.11 | $4,365.16 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $363.08 / $616.60 / $1,288.25
| Professional | | $363.08 | $616.60 | $1,288.25 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $676.08 / $2,187.76 / $5,248.07
| Facility | | $676.08 | $2,187.76 | $5,248.07 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $346.74 / $537.03 / $977.24
| Professional | | $346.74 | $537.03 | $977.24 |