- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $295.12 / $3,981.07 / $10,715.19
| Facility | | $295.12 | $3,981.07 | $10,715.19 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $151.36 / $218.78 / $407.38
| Professional | | $151.36 | $218.78 | $407.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,884.03 / $7,762.47 / $16,595.87
| Facility | | $2,884.03 | $7,762.47 | $16,595.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $141.25 / $218.78 / $407.38
| Professional | | $141.25 | $218.78 | $407.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $269.15 / $724.44 / $4,466.84
| Facility | | $269.15 | $724.44 | $4,466.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $158.49 / $251.19 / $537.03
| Professional | | $158.49 | $251.19 | $537.03 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $645.65 / $2,884.03 / $7,079.46
| Facility | | $645.65 | $2,884.03 | $7,079.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $141.25 / $218.78 / $398.11
| Professional | | $141.25 | $218.78 | $398.11 |