- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $452.03 / $511.09 / $1,645.37
| Facility | | $452.03 | $511.09 | $1,645.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $452.03 / $470.11 / $512.29
| Professional | | $452.03 | $470.11 | $512.29 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $313.39 / $843.78 / $1,187.32
| Professional | | $313.39 | $843.78 | $1,187.32 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $403.60 / $1,298.86 / $2,152.42
| Facility | | $403.60 | $1,298.86 | $2,152.42 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $602.70 / $602.70 / $2,905.01
| Professional | | $602.70 | $602.70 | $2,905.01 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,048.70 / $2,862.83 / $2,862.83
| Facility | | $1,048.70 | $2,862.83 | $2,862.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,001.45 / $3,001.45 / $4,520.25
| Professional | | $3,001.45 | $3,001.45 | $4,520.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $253.13 / $361.62 / $662.97
| Professional | | $253.13 | $361.62 | $662.97 |