- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $776.25 / $3,162.28 / $9,332.54
| Facility | | $776.25 | $3,162.28 | $9,332.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $128.82 / $158.49 / $870.96
| Professional | | $128.82 | $158.49 | $870.96 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,584.89 / $3,715.35 / $9,332.54
| Facility | | $1,584.89 | $3,715.35 | $9,332.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $128.82 / $229.09 / $389.05
| Professional | | $128.82 | $229.09 | $389.05 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $234.42 / $524.81 / $2,137.96
| Facility | | $234.42 | $524.81 | $2,137.96 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $147.91 / $229.09 / $524.81
| Professional | | $147.91 | $229.09 | $524.81 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $645.65 / $1,949.84 / $4,677.35
| Facility | | $645.65 | $1,949.84 | $4,677.35 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $117.49 / $169.82 / $331.13
| Professional | | $117.49 | $169.82 | $331.13 |