- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $894.87 / $1,269.68 / $3,054.40
| Facility | | $894.87 | $1,269.68 | $3,054.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $688.09 / $1,093.51 / $1,573.30
| Professional | | $688.09 | $1,093.51 | $1,573.30 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $813.51 / $1,160.80 / $2,405.04
| Facility | | $813.51 | $1,160.80 | $2,405.04 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $602.08 / $954.60 / $1,442.81
| Professional | | $602.08 | $954.60 | $1,442.81 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $517.53 / $587.86 / $1,025.52
| Facility | | $517.53 | $587.86 | $1,025.52 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $738.00 / $4,127.76 / $4,127.76
| Professional | | $738.00 | $4,127.76 | $4,127.76 |