- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $755.22 / $1,028.08 / $3,747.45
| Facility | | $755.22 | $1,028.08 | $3,747.45 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $534.35 / $790.84 / $926.21
| Professional | | $534.35 | $790.84 | $926.21 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $463.11 / $5,030.85 / $5,408.06
| Facility | | $463.11 | $5,030.85 | $5,408.06 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $377.61 / $818.98 / $1,023.72
| Professional | | $377.61 | $818.98 | $1,023.72 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $299.24 / $641.22 / $712.47
| Facility | | $299.24 | $641.22 | $712.47 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $284.99 / $356.24 / $1,068.71
| Professional | | $284.99 | $356.24 | $1,068.71 |