- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $295.12 / $1,995.26 / $7,413.10
| Facility | | $295.12 | $1,995.26 | $7,413.10 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $190.55 / $323.59 / $741.31
| Professional | | $190.55 | $323.59 | $741.31 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,380.38 / $3,630.78 / $8,709.64
| Facility | | $1,380.38 | $3,630.78 | $8,709.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $154.88 / $269.15 / $501.19
| Professional | | $154.88 | $269.15 | $501.19 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $194.98 / $354.81 / $1,412.54
| Facility | | $194.98 | $354.81 | $1,412.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $190.55 / $316.23 / $660.69
| Professional | | $190.55 | $316.23 | $660.69 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $446.68 / $1,819.70 / $4,570.88
| Facility | | $446.68 | $1,819.70 | $4,570.88 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $169.82 / $257.04 / $489.78
| Professional | | $169.82 | $257.04 | $489.78 |