- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $204.17 / $2,511.89 / $8,128.31
| Facility | | $204.17 | $2,511.89 | $8,128.31 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $79.43 / $173.78 / $436.52
| Professional | | $79.43 | $173.78 | $436.52 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,445.44 / $3,630.78 / $8,709.64
| Facility | | $1,445.44 | $3,630.78 | $8,709.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $79.43 / $141.25 / $288.40
| Professional | | $79.43 | $141.25 | $288.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $138.04 / $426.58 / $1,348.96
| Facility | | $138.04 | $426.58 | $1,348.96 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $95.50 / $199.53 / $426.58
| Professional | | $95.50 | $199.53 | $426.58 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $562.34 / $1,949.84 / $4,677.35
| Facility | | $562.34 | $1,949.84 | $4,677.35 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $79.43 / $165.96 / $338.84
| Professional | | $79.43 | $165.96 | $338.84 |