- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $295.12 / $1,288.25 / $3,715.35
| Facility | | $295.12 | $1,288.25 | $3,715.35 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $120.23 / $173.78 / $281.84
| Professional | | $120.23 | $173.78 | $281.84 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,348.96 / $2,754.23 / $4,073.80
| Facility | | $1,348.96 | $2,754.23 | $4,073.80 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $141.25 / $204.17 / $275.42
| Professional | | $141.25 | $204.17 | $275.42 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $39.81 / $39.81 / $120.23
| Facility | | $39.81 | $39.81 | $120.23 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $426.58 / $426.58 / $426.58
| Facility | | $426.58 | $426.58 | $426.58 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $141.25 / $208.93 / $302.00
| Professional | | $141.25 | $208.93 | $302.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $467.74 / $1,479.11 / $3,981.07
| Facility | | $467.74 | $1,479.11 | $3,981.07 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $120.23 / $169.82 / $281.84
| Professional | | $120.23 | $169.82 | $281.84 |