- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $380.19 / $1,288.25 / $3,890.45
| Facility | | $380.19 | $1,288.25 | $3,890.45 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $138.04 / $295.12 / $501.19
| Professional | | $138.04 | $295.12 | $501.19 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,398.83 / $4,570.88 / $6,456.54
| Facility | | $2,398.83 | $4,570.88 | $6,456.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $181.97 / $316.23 / $549.54
| Professional | | $181.97 | $316.23 | $549.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $39.81 / $2,041.74 / $2,041.74
| Facility | | $39.81 | $2,041.74 | $2,041.74 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $165.96 / $281.84 / $512.86
| Professional | | $165.96 | $281.84 | $512.86 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $831.76 / $2,630.27 / $6,606.93
| Facility | | $831.76 | $2,630.27 | $6,606.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $158.49 / $281.84 / $478.63
| Professional | | $158.49 | $281.84 | $478.63 |