- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $707.95 / $4,365.16 / $10,715.19
| Facility | | $707.95 | $4,365.16 | $10,715.19 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $177.83 / $208.93 / $389.05
| Professional | | $177.83 | $208.93 | $389.05 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,905.46 / $6,025.60 / $12,302.69
| Facility | | $1,905.46 | $6,025.60 | $12,302.69 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $154.88 / $223.87 / $416.87
| Professional | | $154.88 | $223.87 | $416.87 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $331.13 / $691.83 / $2,137.96
| Facility | | $331.13 | $691.83 | $2,137.96 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $186.21 / $269.15 / $575.44
| Professional | | $186.21 | $269.15 | $575.44 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,023.29 / $3,981.07 / $9,549.93
| Facility | | $1,023.29 | $3,981.07 | $9,549.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $154.88 / $218.78 / $398.11
| Professional | | $154.88 | $218.78 | $398.11 |