- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,288.25 / $3,890.45 / $7,762.47
| Facility | | $1,288.25 | $3,890.45 | $7,762.47 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $208.93 / $251.19 / $323.59
| Professional | | $208.93 | $251.19 | $323.59 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $194.98 / $1,023.29 / $5,888.44
| Facility | | $194.98 | $1,023.29 | $5,888.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $234.42 / $288.40 / $467.74
| Professional | | $234.42 | $288.40 | $467.74 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $346.74 / $1,949.84 / $6,165.95
| Facility | | $346.74 | $1,949.84 | $6,165.95 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $223.87 / $281.84 / $380.19
| Professional | | $223.87 | $281.84 | $380.19 |