- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $509.20 / $585.58 / $1,018.40
| Facility | | $509.20 | $585.58 | $1,018.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $585.58 / $585.58 / $585.58
| Professional | | $585.58 | $585.58 | $585.58 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $537.89 / $652.76 / $878.17
| Facility | | $537.89 | $652.76 | $878.17 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $114.17 / $131.72 / $330.39
| Professional | | $114.17 | $131.72 | $330.39 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $413.73 / $860.55 / $1,678.96
| Facility | | $413.73 | $860.55 | $1,678.96 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $585.22 / $585.22 / $731.53
| Professional | | $585.22 | $585.22 | $731.53 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $213.86 / $213.86 / $305.52
| Professional | | $213.86 | $213.86 | $305.52 |