- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $281.84 / $4,897.79 / $11,220.18
| Facility | | $281.84 | $4,897.79 | $11,220.18 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $186.21 / $213.80 / $346.74
| Professional | | $186.21 | $213.80 | $346.74 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,232.93 / $25,703.96 / $35,481.34
| Facility | | $10,232.93 | $25,703.96 | $35,481.34 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $181.97 / $398.11 / $588.84
| Professional | | $181.97 | $398.11 | $588.84 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $199.53 / $323.59 / $436.52
| Facility | | $199.53 | $323.59 | $436.52 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $186.21 / $269.15 / $436.52
| Professional | | $186.21 | $269.15 | $436.52 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,073.80 / $7,762.47 / $10,964.78
| Facility | | $4,073.80 | $7,762.47 | $10,964.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $186.21 / $257.04 / $389.05
| Professional | | $186.21 | $257.04 | $389.05 |