- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $660.69 / $1,047.13 / $1,548.82
| Facility | | $660.69 | $1,047.13 | $1,548.82 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $416.87 / $575.44 / $831.76
| Professional | | $416.87 | $575.44 | $831.76 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $645.65 / $9,772.37 / $41,686.94
| Facility | | $645.65 | $9,772.37 | $41,686.94 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $870.96 / $10,964.78 / $19,498.45
| Professional | | $870.96 | $10,964.78 | $19,498.45 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $812.83 / $812.83 / $891.25
| Professional | | $812.83 | $812.83 | $891.25 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $707.95 / $707.95 / $707.95
| Facility | | $707.95 | $707.95 | $707.95 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $295.12 / $416.87 / $758.58
| Professional | | $295.12 | $416.87 | $758.58 |