- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $288.40 / $2,818.38 / $8,709.64
| Facility | | $288.40 | $2,818.38 | $8,709.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $162.18 / $199.53 / $407.38
| Professional | | $162.18 | $199.53 | $407.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,513.56 / $3,715.35 / $9,549.93
| Facility | | $1,513.56 | $3,715.35 | $9,549.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $154.88 / $229.09 / $446.68
| Professional | | $154.88 | $229.09 | $446.68 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $50.12 / $501.19 / $1,445.44
| Facility | | $50.12 | $501.19 | $1,445.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $181.97 / $263.03 / $588.84
| Professional | | $181.97 | $263.03 | $588.84 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $204.17 / $1,071.52 / $3,467.37
| Facility | | $204.17 | $1,071.52 | $3,467.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $151.36 / $213.80 / $407.38
| Professional | | $151.36 | $213.80 | $407.38 |