- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $512.86 / $3,890.45 / $10,715.19
| Facility | | $512.86 | $3,890.45 | $10,715.19 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $251.19 / $407.38 / $851.14
| Professional | | $251.19 | $407.38 | $851.14 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,398.83 / $6,456.54 / $12,589.25
| Facility | | $2,398.83 | $6,456.54 | $12,589.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $251.19 / $363.08 / $741.31
| Professional | | $251.19 | $363.08 | $741.31 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $295.12 / $512.86 / $2,137.96
| Facility | | $295.12 | $512.86 | $2,137.96 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $269.15 / $436.52 / $954.99
| Professional | | $269.15 | $436.52 | $954.99 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,047.13 / $3,981.07 / $9,549.93
| Facility | | $1,047.13 | $3,981.07 | $9,549.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $239.88 / $380.19 / $691.83
| Professional | | $239.88 | $380.19 | $691.83 |