- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $556.41 / $846.27 / $1,931.27
| Facility | | $556.41 | $846.27 | $1,931.27 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $448.52 / $556.41 / $592.39
| Professional | | $448.52 | $556.41 | $592.39 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $706.42 / $1,050.98 / $2,094.52
| Facility | | $706.42 | $1,050.98 | $2,094.52 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $380.82 / $630.47 / $1,049.45
| Professional | | $380.82 | $630.47 | $1,049.45 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $550.08 / $2,721.94 / $4,856.32
| Facility | | $550.08 | $2,721.94 | $4,856.32 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $592.39 / $1,330.76 / $2,090.29
| Professional | | $592.39 | $1,330.76 | $2,090.29 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $389.28 / $522.49 / $1,499.17
| Professional | | $389.28 | $522.49 | $1,499.17 |