- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $245.47 / $3,548.13 / $10,715.19
| Facility | | $245.47 | $3,548.13 | $10,715.19 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $147.91 / $281.84 / $616.60
| Professional | | $147.91 | $281.84 | $616.60 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,479.11 / $3,715.35 / $9,332.54
| Facility | | $1,479.11 | $3,715.35 | $9,332.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $107.15 / $239.88 / $489.78
| Professional | | $107.15 | $239.88 | $489.78 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $239.88 / $446.68 / $1,584.89
| Facility | | $239.88 | $446.68 | $1,584.89 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $151.36 / $295.12 / $676.08
| Professional | | $151.36 | $295.12 | $676.08 |
- 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
- $131.83 / $239.88 / $478.63
| Professional | | $131.83 | $239.88 | $478.63 |