- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $436.52 / $3,311.31 / $9,332.54
| Facility | | $436.52 | $3,311.31 | $9,332.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $251.19 / $331.13 / $630.96
| Professional | | $251.19 | $331.13 | $630.96 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,290.87 / $6,165.95 / $14,125.38
| Facility | | $2,290.87 | $6,165.95 | $14,125.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $251.19 / $346.74 / $645.65
| Professional | | $251.19 | $346.74 | $645.65 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $407.38 / $758.58 / $4,168.69
| Facility | | $407.38 | $758.58 | $4,168.69 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $263.03 / $398.11 / $794.33
| Professional | | $263.03 | $398.11 | $794.33 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,047.13 / $4,265.80 / $10,471.29
| Facility | | $1,047.13 | $4,265.80 | $10,471.29 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $234.42 / $338.84 / $602.56
| Professional | | $234.42 | $338.84 | $602.56 |