- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $758.58 / $1,096.48 / $2,290.87
| Facility | | $758.58 | $1,096.48 | $2,290.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $416.87 / $562.34 / $741.31
| Professional | | $416.87 | $562.34 | $741.31 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $831.76 / $1,202.26 / $2,041.74
| Facility | | $831.76 | $1,202.26 | $2,041.74 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $338.84 / $630.96 / $1,819.70
| Professional | | $338.84 | $630.96 | $1,819.70 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $489.78 / $489.78 / $4,365.16
| Facility | | $489.78 | $489.78 | $4,365.16 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,023.29 / $1,412.54 / $1,659.59
| Professional | | $1,023.29 | $1,412.54 | $1,659.59 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $363.08 / $457.09 / $1,348.96
| Professional | | $363.08 | $457.09 | $1,348.96 |