- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $288.40 / $2,754.23 / $8,511.38
| Facility | | $288.40 | $2,754.23 | $8,511.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $165.96 / $213.80 / $524.81
| Professional | | $165.96 | $213.80 | $524.81 |
- 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
- $147.91 / $213.80 / $436.52
| Professional | | $147.91 | $213.80 | $436.52 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $245.47 / $549.54 / $1,548.82
| Facility | | $245.47 | $549.54 | $1,548.82 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $177.83 / $288.40 / $588.84
| Professional | | $177.83 | $288.40 | $588.84 |
- 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
- $154.88 / $234.42 / $446.68
| Professional | | $154.88 | $234.42 | $446.68 |