- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $281.84 / $3,388.44 / $8,912.51
| Facility | | $281.84 | $3,388.44 | $8,912.51 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $125.89 / $208.93 / $398.11
| Professional | | $125.89 | $208.93 | $398.11 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,698.24 / $4,677.35 / $13,489.63
| Facility | | $1,698.24 | $4,677.35 | $13,489.63 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $141.25 / $223.87 / $426.58
| Professional | | $141.25 | $223.87 | $426.58 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $218.78 / $812.83 / $1,949.84
| Facility | | $218.78 | $812.83 | $1,949.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $144.54 / $257.04 / $562.34
| Professional | | $144.54 | $257.04 | $562.34 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,584.89 / $4,365.16 / $10,232.93
| Facility | | $1,584.89 | $4,365.16 | $10,232.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $123.03 / $208.93 / $407.38
| Professional | | $123.03 | $208.93 | $407.38 |