- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $371.54 / $2,818.38 / $8,912.51
| Facility | | $371.54 | $2,818.38 | $8,912.51 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $138.04 / $288.40 / $524.81
| Professional | | $138.04 | $288.40 | $524.81 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,548.13 / $6,025.60 / $13,489.63
| Facility | | $3,548.13 | $6,025.60 | $13,489.63 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $151.36 / $239.88 / $467.74
| Professional | | $151.36 | $239.88 | $467.74 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $34.67 / $812.83 / $2,290.87
| Facility | | $34.67 | $812.83 | $2,290.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $169.82 / $331.13 / $707.95
| Professional | | $169.82 | $331.13 | $707.95 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $288.40 / $1,148.15 / $3,630.78
| Facility | | $288.40 | $1,148.15 | $3,630.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $158.49 / $316.23 / $616.60
| Professional | | $158.49 | $316.23 | $616.60 |