- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $517.37 / $2,703.13 / $4,151.03
| Facility | | $517.37 | $2,703.13 | $4,151.03 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $464.58 / $517.37 / $1,157.40
| Professional | | $464.58 | $517.37 | $1,157.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,044.80 / $1,149.33 / $1,347.66
| Professional | | $1,044.80 | $1,149.33 | $1,347.66 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $639.51 / $1,277.66 / $1,701.85
| Professional | | $639.51 | $1,277.66 | $1,701.85 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $517.37 / $739.58 / $1,064.15
| Facility | | $517.37 | $739.58 | $1,064.15 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $541.34 / $949.12 / $1,340.52
| Professional | | $541.34 | $949.12 | $1,340.52 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $541.34 / $949.12 / $1,190.95
| Professional | | $541.34 | $949.12 | $1,190.95 |