- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $643.16 / $1,781.58 / $3,114.27
| Facility | | $643.16 | $1,781.58 | $3,114.27 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $507.76 / $643.16 / $795.49
| Professional | | $507.76 | $643.16 | $795.49 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,083.23 / $2,437.26 / $4,083.59
| Facility | | $1,083.23 | $2,437.26 | $4,083.59 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $355.43 / $355.43 / $846.27
| Professional | | $355.43 | $355.43 | $846.27 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $484.07 / $566.58 / $2,585.38
| Facility | | $484.07 | $566.58 | $2,585.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,036.47 / $1,036.47 / $1,227.08
| Professional | | $1,036.47 | $1,036.47 | $1,227.08 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $643.16 / $846.27 / $1,184.78
| Facility | | $643.16 | $846.27 | $1,184.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $677.02 / $1,184.78 / $1,692.54
| Professional | | $677.02 | $1,184.78 | $1,692.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $355.43 / $355.43 / $507.76
| Professional | | $355.43 | $355.43 | $507.76 |