- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $217.83 / $413.26 / $18,107.48
| Facility | | $217.83 | $413.26 | $18,107.48 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $205.62 / $256.76 / $11,231.55
| Professional | | $205.62 | $256.76 | $11,231.55 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $178.24 / $708.50 / $1,166.14
| Facility | | $178.24 | $708.50 | $1,166.14 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $136.15 / $198.04 / $1,295.03
| Professional | | $136.15 | $198.04 | $1,295.03 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $203.58 / $203.58 / $203.58
| Facility | | $203.58 | $203.58 | $203.58 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $203.58 / $203.58 / $203.58
| Professional | | $203.58 | $203.58 | $203.58 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $194.41 / $256.76 / $333.79
| Facility | | $194.41 | $256.76 | $333.79 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $212.20 / $212.20 / $234.10
| Professional | | $212.20 | $212.20 | $234.10 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $203.58 / $203.58 / $212.20
| Professional | | $203.58 | $203.58 | $212.20 |